CalCPA ProtectPlus

Recently the owner of a CalCPA-member firm contacted Banyan Administrators, LLC, managers of the CalCPA ProtectPlus health and welfare programs, about adding a new employee to his firm’s ProtectPlus medical plan. The new employee, it turned out, was a close relative, and the owner wanted to get him enrolled and covered as soon as possible—preferably, right away.

The fact that the new employee was related had, in fact, no bearing on how the matter was handled. What was relevant, however, was the firm’s written policy, clearly spelled out in its benefit plan subscription agreement (an employer’s master application and agreement with the Group Insurance Trust or other carrier), that new employees had to complete a two-month waiting period before being eligible for benefits. Naturally, the firm’s owner was disappointed that his relative would have to wait the same as any other new hire. Nevertheless, he was also appreciative that Banyan had helped him keep his firm in compliance with both HIPAA and ERISA rules. The Department of Labor (DOL) is concerned about fair treatment of employees and issues of discrimination immediately arise if employees are not treated equally.

Because Banyan service center representatives had the information at their fingertips in their computer system, they were able to provide an explanation to the firm’s owner on the phone. Even if the owner had not contacted Banyan proactively, Banyan would have flagged the employee’s enrollment form when it came in because it did not meet the employer’s established policy. An important feature of Banyan’s computerized recordkeeping is to help member firms prevent unintended regulatory violations.

At the same time, the Trust provides flexibility by offering member firms a broad range of options in setting their own policies. A firm can choose to add new hires to their existing plans on the first of the month following the day of hire or up to six months after, provided they are consistent. Existing rules are subject to change as the Patient Protection and Health Care Affordability Act (health care reform) is implemented and the specifics of the law are ironed out. The Trust and Banyan will continue to monitor evolving regulations and keep you informed as health care reforms solidify.

Generally, employers may change their benefit waiting period and other employee eligibility policies during the annual open enrollment period. It makes sense to review these policies each year to ensure that they are consistent with your firm’s hiring practices. If you are not sure about your company’s benefits eligibility policy as stated in your ProtectPlus Subscription Agreement, or if you are not sure whether the subscription agreement is consistent with your employee handbooks or other new-hire materials, call the Banyan Service Center at (877) 480-7923 or email cpaprotectplus@banyan-llc.com. A Banyan member service representative will be happy to answer your questions.

The IRS announced on May 24^th that the 2011 limits for health savings accounts (HSAs) and for high-deductible health plans (HDHPs) will remain unchanged from 2010. Each year the IRS provides new inflation-adjusted limits for qualifying HSA contributions, deductibles, and out-of-pocket maximums. The IRS has determined that the change in inflation was not enough to alter the 2011 HSA contributions limits.

The maximum HSA contribution that can be made next year is $3,050 for single or self-only coverage and $6,150 for family coverage. In addition, the minimum deductible will stay at $1,200 for single coverage and $2,400 for family coverage. The maximum out-of-pocket employee expense, including deductibles, will stay at $5,950 for single coverage and $11,900 for family coverage. The catch-up contribution for those age 55 and older will also remain the same at $1,000.

According to a survey performed by America’s Health Insurance Plans, a Washington-based trade group, as of January 1, about 10 million people were enrolled in high-deductible health insurance plans to which HSAs must be linked which is a 25 percent increase over the last year. This shows just how popular these accounts are becoming.

For further information click here to read the revised (June 7, 2010) Internal Revenue Bulletin: 2010-23.

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The old idiom with the words, “two is company,” was reinforced at a recent CalCPA member event. A ProtectPlus staff member was chatting with an accountant who described himself as a sole practitioner while mentioning that he had an assistant. He subscribed to ProtectPlus as a sole practitioner, he said, because the person who helped him already had medical coverage through her spouse’s employer, and she wanted to keep that coverage.

Alerted to a possible misunderstanding, the ProtectPlus representative responded by pointing out that under ProtectPlus rules even if his employee waived coverage, the accountant qualified for the lower premiums of firms with 2 to 14 employees. In addition, if the firm ever moved to another carrier, it would not be subject to underwriting to qualify for coverage. Moreover, simply having that employee on staff is enough to qualify for the lower rates as long as the employee is working a minimum of 20 or 30 hours a week. Even if the employee waives the benefit—whether because he or she has other group insurance coverage or a Kaiser plan—the CPA still qualifies for coverage at the two-member firm rate.

ProtectPlus subscribers should keep in mind that the same rules apply to a CPA sole practitioner who employs his or her spouse. As long as the spouse works at least 20 hours per week and is compensated as an employee, the CPA firm is defined as a group of two. The CPA can purchase a ProtectPlus policy at the lower rate, forego underwriting, and choose whether to include the spouse as a dependent on his or her policy, or cover the spouse as an employee under their own policy. However, in firms where the only other employee is the spouse, the Trust requires documentation (W-2, payroll records, income tax returns, etc.).

For CalCPA members—especially sole practitioners and small firms—one of the greatest benefits of the Group Insurance Plans is access to high quality medical insurance at prices that are competitive to those usually offered to large firms. While true sole practitioners are subject to underwriting, the ProtectPlus policies available to them will for the most part be miles ahead of anything they can purchase on the individual market. And even those who don’t qualify for coverage due to their medical history may qualify for a ProtectPlus HIPAA option. For more information please contact Banyan Administrators (877) 480-7923.

The following information if from Anthem Blue Cross and is quite helpful in guiding you to a healthier lifestyle.

Are you or a family member living with a chronic condition such as asthma, diabetes or heart disease? If so, we can help. 360˚ Health provides you with support to help you achieve your health goals. We’ll work with you, your doctor and other health care professionals to help you improve your health.

ConditionCare enhances your doctor’s plan of care through the use of a dedicated nurse plus a team of health professionals including dietitians, exercise physiologists, pharmacists and more. You can gain a better understanding of your health, receive help in following your doctor’s care plan and learn how to better manage your health. This program is designed to help members with chronic conditions such as asthma, diabetes, coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD) and heart failure.

ConditionCare Support Programs complement our core ConditionCare programs. They assist members who are not managing a core chronic condition, such as asthma or diabetes, but need help with other conditions ranging from arthritis pain to high blood pressure. These programs include help with vascular at-risk conditions, low back pain, musculoskeletal conditions, and various types of cancer.

ConditionCare Kidney Disease is a program specifically designed to support members with chronic kidney disease. Nurses that specialize in renal care and the treatment of kidney disease provide education and support to help members manage their health.

ComplexCare provides help to those with multiple health concerns who may require high levels of collaborative care. Personalized nurses who specialize in treating multiple health conditions work with members to help improve their health.

Comprehensive Medical Management provides one-on-one expert assistance to help members find and receive the right services and care. The program includes a personal advocate to see that benefits are utilized effectively and that necessary medical interventions are appropriate and safe.

360° Health program offerings vary by state. Specific programs are included in your health plan and others are available for additional cost. Contact your human resources department or benefits administrator as appropriate for eligibility and further details.

Take your next step to better health. Choose a link:

• 360° Health Overview
• Improve Your Health
• Get Guidance

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The following information is from VSP.com

All in the Family? A Primer on Genes and Vision Problems

Ah, the wonderful world of genetics. There’s the classic “family nose,” the disarming blue eyes, or the shock of thick, curly hair at birth. True, some things run in families. What about vision problems?

Some do. Others tend to be influenced by environmental or other factors, says J.P. Lowery, O.D., M.Ed. Dr. Lowery is chief of pediatrics at Pacific University College of Optometry in Forest Grove, Oregon.

She says, “Nearsightedness and farsightedness have a strong genetic component, especially if a parent is very nearsighted or farsighted. If both parents are nearsighted or farsighted, there’s a good chance their child will be the same.”

But vision isn’t all in the genes, Dr. Lowery continues. “There are some significant environmental influences, such as near-point work like reading, that are associated with nearsightedness, especially when it develops later in the teens and 20s.” Some studies suggest that students who spend a lot of time reading develop nearsightedness more quickly than others do.

Some genetically-linked eye problems:

• Nearsightedness
• Farsightedness
• Color vision deficiency (a.k.a., color blindness)
• Retinitis pigmentosa, a rare progressive decline of the retina
• Some eye problems that have mixed causes:
• Glaucoma (fluid build-up in the eye that damages the optic nerve)
• Age-related macular degeneration (progressive decline of part of the retina)
• Amblyopia (“lazy eye”)
• Strabismus (when eyes are aligned in different directions)

Amblyopia and strabismus usually show up in very early childhood, and there’s great success treating them with patches, special eyewear, vision training and/or surgery.

If you’re curious about your family’s vision history and how it might impact your children, see an eye doctor. Dr. Lowery says, “As a pediatric eye specialist, I can tell you that many of the serious vision problems that young children develop could be prevented if all parents brought their babies in for routine eye exams at six months.” You might be surprised how easy an eye exam on an infant can be, but the right doctor with child-friendly tools can get it done in a snap.

Dr. Lowery recommends additional exams around 3 years old, then just before kindergarten. Yearly eye exams should continue for life.

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Over the last few weeks the Group Insurance Trust has received a number of phone calls in response to headlines about significant premium increases recently proposed by Anthem Blue Cross. In fact, it turns out that Blue Cross is just one of many major insurers in California and throughout the nation who are contemplating big rate hikes. The good news, which Trust staff has repeated to these callers, is that ProtectPlus subscribers are not subject to the threatened rate increases that are so much in the news.

Since being licensed by the State of California as a Multiple Employer Welfare Arrangement (MEWA) in 1997, the Trust has acted as the insurer for the entire ProtectPlus medical, dental and vision plans, designing benefits to meet the needs of CalCPA members and setting its own rates.

The Trust’s executive director, Susan Young, notes, “The confusion may have arisen because the Trust contracts with Anthem Blue Cross for use of its Prudent Buyer Network and to adjudicate claims. The Trust has an administrative-services-only agreement for which it pays Anthem a negotiated fee per member, per month, for the services it provides.”  Young adds, “Although ProtectPlus members get the advantage of Anthem’s deep provider discounts, members should understand that it is the Trust that is responsible for setting ProtectPlus premium rates and benefits, which are based on our group’s claims experience. This is why the recent threatened increases by Anthem and others do not directly affect ProtectPlus members.”

For CalCPA members who are not yet taking advantage of the remarkable benefits found in the Trust program, this is an excellent time to see how their present plan stacks up against the ProtectPlus plans. Solo practitioners and members with small group plans who are facing big increases may well find that ProtectPlus offers them superior coverage at significantly lower rates. (continue reading…)

The following information is from IRS.gov and is very beneficial to those who have an HSA account.

Death of HSA Holder

You should choose a beneficiary when you set up your HSA. What happens to that HSA when you die depends on whom you designate as the beneficiary.

Spouse is the designated beneficiary.   If your spouse is the designated beneficiary of your HSA, it will be treated as your spouse’s HSA after your death.

Spouse is not the designated beneficiary.   If your spouse is not the designated beneficiary of your HSA:

· The account stops being an HSA, and

· The fair market value of the HSA becomes taxable to the beneficiary in the year in which you die.

If your estate is the beneficiary, the value is included on your final income tax return.

TIP: The amount taxable to a beneficiary other than the estate is reduced by any qualified medical expenses for the decedent that are paid by the beneficiary within 1 year after the date of death.

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The following information is from IRS.gov and is very beneficial to those who have an HSA account.

You may enjoy several benefits from having an HSA. Here are some of the benefits:

• You can claim a tax deduction for contributions you, or someone other than your employer, make to your HSA even if you do not itemize your deductions on Form 1040.
• Contributions to your HSA made by your employer (including contributions made through a cafeteria plan) may be excluded from your gross income.
• The contributions remain in your account from year to year until you use them.
• The interest or other earnings on the assets in the account are tax free.
• Distributions may be tax free if you pay qualified medical expenses. See qualified medical expenses below.
• An HSA is “portable” so it stays with you if you change employers or leave the work force.

Qualified medical expenses.  Qualified medical expenses are those expenses that would generally qualify for the medical and dental expenses deduction. However, even though non-prescription medicines (other than insulin) do not qualify for the medical and dental expenses deduction, they do qualify as expenses for HSA purposes. (continue reading…)

If you’re looking ahead toward a big birthday this year—one of those marked by a round number, a party, and jokes about getting older—then among the surprises that may await you is an increase in your health insurance rates.

This unwelcome gift—in addition to the seemingly inevitable yearly rate increase that everyone gets—comes in the form of a higher premium and marks your status in having moved to another age rate band.

You’re probably aware that older people pay more for their health insurance and younger people less, and you may have already experienced such an increase.

Nevertheless, in these lean times, its not something you want to come as a surprise. “Happy birthday! Blow out the candles! Your premium just went up $100 a month!” ProtectPlus uses a range of age bands that are common in health insurance plans:

• under 30
• 30–39
• 40–49
• 50–54
• 55–60
• 60–64
• 65 and older

If you’re with another insurer, you should check to see where the bands fall on your policy. You can’t avoid getting older, of course, but if a higher premium will create a financial burden, you can switch to a less expensive plan during open enrollment (November 2 to December 31). Otherwise, you will have to live with the higher rates for your newly attained age until the next year.

Keep in mind that the rates for your spouse and dependents are dependent on your age band, so their big birthdays don’t count in terms of premiums. You can celebrate as you see fit, and not have to worry about higher rates on their birthdays.

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Vision Service Plan benefits include periodic check-ups, frames, lenses, and contacts, but its up to you to know when you are eligible for these benefits. You can access eligibility information, and more, online in your own password protected area of the Vision Service Plan website. That way, as soon as you know you are eligible for benefits, you can schedule your next eye exam, or get the new pair of glasses or contact lenses that you’ve been wanting.

To access your account visit your plans login on the ProtectPlus website.

1. Next, you can select among medical, dental, and vision plans. When you click on “vision,” you will be taken to the VSP login page where you will need to register if you haven’t already done so.
2. Once you have logged in, you will see a page that lists each benefit with an entry that specifies if you are currently eligible or the date on which you will gain eligibility.
3. You can also view the online “savings statement” from your last vision appointment to see how much you saved by using your vision plan benefits.

This is a short presentation that covers the new form “Group Insurance Change Report” for CalCPA ProtectPlus Group Insurance Plans, what it is and how to use it. Click the image below to view presentation.

Presentation Highlights:
•    Move Employees between health plans
•    Remove Life or Disability from all employees
•    Declare which health plans you will be offering (any combinations)

The end of the calendar year marks the ProtectPlus annual open enrollment period. It’s also the time to make plan changes. For employees who opted not to enroll in ProtectPlus for whatever reason, this is another chance to join. For current subscribers it’s an opportunity to make changes in their coverage.

Maintaining the longer open enrollment period adopted in 2007, the Group Insurance Trust has announced that open enrollment begins on November 2 and ends December 31.

CalCPA member firms that haven’t offered ProtectPlus plans to their employees can, of course, enroll in Group Insurance Trust plans at any time.

Firms can consider the full range of offerings for 2010 that include;

• 5 copay plans
• 3 HSA-eligible plans
• 2 Anthem Blue Cross HMO plans

This is also the time of year that the Trust announces plan changes and premium adjustments. As always, premium  increases are anticipated with concern, but the good news is:

The Trust has been able to maintain its single digit  premium increases for the seventh consecutive year.

This is a remarkable achievement when you consider that ProtectPlus also beat industry averages in each of these years.

Several benefit improvements will be implemented in 2010.

• All ProtectPlus copay plans will see a reduction in the copay amount for generic prescription drugs from $15 to $10.
• Improved coverage for mental health and substance abuse services on all copay, HSA-eligible, and Anthem Blue Cross HMO plans.
• Medical plans will now align all mental health and substance abuse member cost-sharing provisions with those offered for in-network and out-of-network medical services and remove any visit limitations (in accordance with the Mental Health Parity and Addiction Equity Act of 2008).

The Trust will also combine several copay plans for 2010.
Last year the Trust offered eight copay plans, including both regular and enhanced versions of:

• Protect 15
• Protect 25
• Protect 35

The enhanced versions of these plans—which waive the deductible for the first six in-network office visits—proved so popular that trustees were persuaded to include the enhanced benefits as standard features in the copay plans at these levels.

For 2010 the Protect 15, Protect 25 and Protect 35 plans will all feature the enhanced benefit of six office visits that are not subject to the plan’s deductible, while the Protect 10 and Protect 45 plans will retain their original structure.

Vision Service Plan and Delta Dental rates will be restructured for 2010.
Going forward, rates for both plans will be based on firm size in much the same way the medical plan rates are structured.

• Effective January 1, 2010, firms with two or more participants will see a reduction in VSP and Delta Dental rates while others will note a small increase.

Changes in Premiums
Some ProtectPlus members will see changes in their premiums next year that reflect altered geographical rate bands. Anthem Blue Cross has re-aligned several zip codes in rate areas one, two, and three, and the Trust has followed its lead in order stay consistent. For some, these changes will mean lower than average premium increases, while for others, unfortunately, it may mean an increase in excess of the average overall premium increase.

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The Group Insurance Trust has always made a priority of providing CalCPA  members the first-class service that they deserve. This goal is expressed in the quality benefit plans offered by the Trust, the range of choices, and the customer service that supports the use of those plans on a daily basis. Aiming to enhance this experience even further, the Trust has recently contracted with Banyan Administrators, LLC, to handle the administrative services formerly provided by Seabury & Smith.

About this Change
Susan Young, executive director of the Group Insurance Trust commented,

In light of Seabury’s long service to the Trust, deciding to move our account wasn’t easy. However, in seeking the best possible service for our members, we wanted to take advantage of Banyan’s skills.

Starting November 1, 2009, Banyan will be responsible for the following:

• Customer service
• Billing
• Payment processing
• Record-keeping
• Marketing support
• Receiving and accounting for participant contributions
• Maintaining records of eligible participants
• Preparing financial reports for GIT staff and trustees
• Banyan will also process all enrollment and change applications
• Maintain an interface with Anthem Blue Cross
• Help new firms and new employees set up their accounts, and manage employee eligibility

For many ProtectPlus members, of course, the primary and often the only point of contact with the plan administrator is when they call or email with a question. Banyan brings to this customer service role a history of serving 220 organizations and group plans beginning in 1994, including other MEWAs (Multiple Employer Welfare Arrangements) in its home state of Pennsylvania that have similar needs and concerns as the Group Insurance Trust. Scott Fair, executive vice president of Banyan, is very clear about “how important customer service interactions are in presenting the face of an organization.”

Banyan Customer Service Center
The Banyan customer service center is staffed by Banyan representatives—all  are licensed brokers—who are there to answer your questions whether by phone or email. Moving all these services to a higher level, Banyan brings with it a high degree of technological sophistication, so that relevant information will be more quickly and easily accessible. For a benefits  administrator this can mean resolving an eligibility issue online, and for Trust staff, the ability to monitor plan performance more closely. (continue reading…)

How-to Understand Your New Invoice

This is a short presentation that covers the new invoices provided by CalCPA ProtectPlus, and how to understand them. Click the image below to view the presentation.

Presentation Highlights:

• Format
• New Invoice – December 15th
• Employee Monthly Premiums
• Benefit Totals & Payments
• Payment Stubs

Contact Info

Banyan Administrator for CalCPA ProtectPlus

Here is an introductory presentation to Banyan Administrators, the new administrators of CalCPA ProtectPlus, and some highlights of the improvements you can expect to see over the next couple of months as we make this transition. Click image below to view presentation.

Presentation Highlights:
Improvements

• Simplified enrollment process
• Improved program invoice design
• Enhanced communication capabilities – new web features
• Streamlined administration leveraging web-based technology

What’s Next

• Detailed Administrative Guide
• Annual Open Enrollment Communications

New Contact Info

Easy-to-use, clear, and helpful, the redesigned CPA ProtectPlus website offers a wide variety of new tools addressing the insurance needs and benefits questions of CalCPA members.

Give these new features a try!

Plan Selector Tool. Analyzing your responses to a short series of questions, this new selector tool identifies three health plans suited to your needs. You can click through to each of the selected plans and view a description of its benefits. In addition, the tool displays a graph comparing the relative premiums of all available ProtectPlus plans.

Member Satisfaction Survey. Whether you are a current or former ProtectPlus plan participant, we want your feedback, and we’ve made it easy for you. Just click on the member satisfaction tab to let us know about your experience and what is important to you.

Firm Administrator’s Tab. For firms that wish to manage some of their own ProtectPlus account functions, this tab will soon be the portal to the firm’s own self-management site. It already features a series of important links, including a twelve-page PDF Administrative Guide with contact information, payment information, rules and recent changes. The tab also provides links to a host of PDF forms (enrollment forms, claims forms, the new 2010 rate sheets, HIPAA information, prescription drug preauthorization forms, plan descriptions, brochures, and the 2010 ProtectPlus EZ Guide). A series of multi-media E-Presentations give administrators information on how the ProtectPlus program operates. Finally, a Contact Information option has links to an insurance glossary and FAQs, as well as a list of companies, institutions, and people who can help with your insurance needs.

Blog, Twitter, and Facebook Links. Expand your network while making sure you get the news from CalCPA as it happens. ProtectPlus is blogging, tweeting, and networked.

Ask the Sales Manager Link. Too busy to pick up the phone? Want a quote? Have a question but it’s too complicated to leave in a phone message? Just fill in the online form and CalCPA sales manager Tom Kowalski will get back to you ASAP.

The CalCPA Daily Dose Widget link brings you top news items that refresh daily. You’ll receive late-breaking news about health and medicine, stocks, sports, business and finance.

Revised Quote Tool. You can now choose to get a quote as a guest, or you can create an account. If you choose to create an account, the system automatically saves each quote you request so you can return at any time to view prior quotes. On each visit you can get  a detailed quote with the cost for each employee, or you can get a “quick view” premium summary.

Open enrollment is going on now through December 31st. See why so many CalCPA member firms choose CalCPA ProtectPlus. Each of our plans have been developed through research, member feedback, and collaboration with leading national service providers to deliver an attractive balance of benefits and savings. And because these are proprietary plans, we can provide them to our member firms at highly competitive group rates.

You may choose to offer your employees almost any combination of the CalCPA ProtectPlus plans. This exclusive coverage is a great enticement for attracting and retaining top-level talent to your firm.

Here is a quick look at our plans.

To find the plan that be fits your needs, please use our Plan Selector Tool.

• Protect 10 $10 copay, 10% coinsurance, 
individual deductible $250/Family $500. More details

• Protect 15 $15 copay, 20% coinsurance, Individual deductible $250/Family $500, the first 6 in-network office visits per calendar year are exempt from annual deductible. More details

• Protect 25 $25 copay, 30% coinsurance, Individual deductible $500/Family $1,000,the first 6 in-network office visits per calendar year are exempt from annual deductible. More details

• Protect 35 $35 copay, 40% coinsurance, Individual deductible $500/Family $1,000, the first 6 in-network office visits per calendar year are exempt from annual deductible. More details

• Protect 45 $45 copay, 50% coinsurance, no in-network deductible. More details

• Protect HSA 1500 $1,500 Individual deductible $1,500/Family $3,000, 30% coinsurance, $4,500 Individual out-of-pocket maximum. More details

• Protect HSA 2500 $2,500 Individual deductible $2,500/Family $5,000, -0- coinsurance, $2,500 Individual out-of-pocket maximum. More details

• Protect HSA 2850 $2,850 Individual deductible $2850/Family $5,650, 30% coinsurance, $5,500 Individual/ out-of-pocket maximum. More details

• HMO Value 80 $15 copay, no deductible, 20% coinsurance for most covered expenses. More details

• HMO Advantage 100 $10 copay, no deductible, no additional charge for most covered expenses. More details

As mentioned in a previous posting there are plenty of new features coming for ProtectPlus policy holders. But, there will also be some great new tools on the website.

We will be launching a plan selector tool that will ease the process of selecting the right plan options for your firm. This tool will be in the form of a quick survey that will result in a recommendation of the three plans that are most likely to suit your needs. We are very excited about this new tool, and we think you will enjoy its ease of use as well!

Be sure to let us know what you think of it, once you’ve tried!

In the next several weeks, please be on the lookout for important announcements pertaining to the CalCPA ProtectPlus programs. We are making changes that will lead to improvements in program billing, customer service and technology usage.  Information will be distributed via the CalCPA ProtectPlus website, CPA eFocus newsletter, Twitter, direct mailings, Brainshark multi-media presentations and other communication resources.  Stay tuned for more information!

Did you know that although most employers will elect to have partners and employees covered under a single plan, firms may chose to offer one or more, or all of CalCPA ProtectPlus plans to their owners and employees. However, if the firm wishes to include an HMO plan, only one the the Anthem Blue Cross plans may be offered.

Learn more about CPA ProtectPlus healthcare plans