Covered California FAQ

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Covered California FAQ 加州全保常見問題





The Covered California enrollment period is upon us! Whether you are an employer or employee, we get that you might still have any questions or doubts regarding the process.

加州全保的註冊期即將開始!無論您是雇主還是員工,我們知道您可能對註冊流程仍有問題或疑慮。


That is why we compiled some frequently asked questions so you can ensure you and your company have a headache-free enrollment period.

我們整理了一些常見問題,以確保您和您的公司有一個無憂無慮的註冊過程。



How do I know my status as an employer? How does size affect my obligations?

如何確定我作為雇主的身份?公司規模將如何影響我的責任?


If you have 50 or more FTEs, you are a large employer, and you must offer health coverage that is both affordable and that meets a minimum value to your employees. The law also requires ALEs to offer coverage to employees for their dependent children below the age of 26. ALEs that do not provide health coverage could face a penalty from the Internal Revenue Services (IRS), referred to as the Shared Responsibility Payment. This penalty is triggered when an employee who is not offered coverage by an ALE purchases health insurance on a state or federal health exchange and receives a federal subsidy to help pay for that coverage.

如果您擁有50名或更多的全職員工,則您是一家大型公司雇主,您必須為您的員工提供既負擔得起又可以滿足基本需求的健康保險。法律還要求適用的大型雇主為員工的26歲以下被撫養子女提供保險。不提供健康保險的適用的大型雇主可能面臨國稅局 (IRS) 的處罰,稱為分擔責任付款。當未獲得適用的大型雇主的保險的員工,在州或聯邦健康交易所購買健康保險並獲得聯邦補貼以幫助支付該保險時,就會啟動該處罰。


California recently expanded the group size definition of a small business to include any business with at least one but no more than 100 FTEs. Historically, a small group size (in the health insurance industry) determinates employers having up to 50 FTEs. With the recent expansion, employers with 51- 100 FTEs are now also considered a small group. CCSB changed its eligibility requirements to align with the state expansion of the small group, which means that employers with up to 100 FTEs may be eligible to enroll in the program.

加州最近將小型公司的團體規模定義擴大到包括至少一個但不超過100名全職員工的任何公司。以前,小團體規模(在健康保險行業)允許雇主可以擁有多達50名全職員工。隨著最近的擴張,擁有51-100名全職員工的雇主現在也被視為一個小團體。 CCSB更改了其資格要求,以配合小團體的擴張,這意味著擁有最多100名全職員工的雇主可能有資格參加該計劃。



What if my employee's or dependent's eligibility status changes?

如果我的員工或被扶養人的資格狀態發生變化怎麼辦?


As a health plan sponsor, you are required to report any changes in your employees’ eligibility to CCSB. Changes that should be reported include an employee’s:

作為健康計劃保證人,您需要向CCSB報告您員工資格的任何變化。需要報告的員工變更狀態包括:


• Change of address 更換地址

• Change in work hours or work relationship 工作時間或工作關係的變化

• Loss or gain to other health coverage 其他健康保險的賠償或增加

• Change on dependent status被扶養人的狀態變化

• Termination of employment終止僱傭關係

Death過世


All changes should be submitted using an Employee Change Request Form within 30 days.

所有變更均應在30天內使用員工變更申請表提交。



How do I qualify for a special enrollment window?

我如何獲得特殊註冊期的資格?


Employees and their dependents can enroll outside of open enrollment if they experience a Qualifying Life Event (QLE). Qualifying life events allow employees, spouses, and/or their dependent(s) to be eligible for health care benefits outside the annual open enrollment period. If an employee waives coverage during Open Enrollment, they must either wait for the next annual open enrollment period or have a qualifying life event to enroll in your group health coverage.

如果員工及其被扶養人經歷了合格的生活事件 (QLE),則可以在開放註冊之外註冊。符合條件的生活事件允許員工、配偶和/或其被扶養人在年度開放註冊期之外有資格獲得醫療保健福利。如果員工在開放註冊期間放棄保險,他們必須等待下一個年度開放註冊期或有符合條件的生活事件才能註冊您的團體健康保險。



Source 來源: https://www.coveredca.com






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