Contract Awarded to Pinnacle Claims Management, Inc.to
Administer Innovative, Affordable Marketplace
Sacramento, Calif. -- The Covered California Board has approved
Irvine-based Pinnacle Claims Management, Inc. (PCMI) to administer its Small
Business Health Options Program (SHOP). The program will offer approximately
375,000 California small businesses unprecedented access to a considerable
array of affordable health coverage options for its employees. California is
one of a few states nationally that will be able to offer small businesses an
array of health insurance options for their employees come this fall.
This contract is supported by federal funds provided under the Affordable Care Act, and continued funding will be provided by Covered California administrative revenue starting in 2015.
This contract is supported by federal funds provided under the Affordable Care Act, and continued funding will be provided by Covered California administrative revenue starting in 2015.
“We are excited to partner with PCMI in this historic moment
when we can help thousands of small businesses provide affordable health care
for their employees,” said Peter V. Lee, Executive Director for Covered
California. “PCMI has demonstrated the requisite knowledge of California’s
small business community and has shown us they can move quickly and effectively
in providing all the services we require to help Covered California get up and
running this fall.”
Small employers participating in the SHOP will be able to
provide their employees with a broader choice of health plans that generally has
only been available to large employers. Certain small businesses — those with
25 or fewer full-time equivalent employees paid an average annual wage of less
than $50,000 — may be eligible to receive a 50 percent small business health
care tax credit for coverage purchased through the SHOP.
Through SHOP, employers will be able to pick the level of
support for their employees, and in turn employees will be able to pick from
those options the specific health plan that is right for them and their
families. All plans will provide a standardized set of benefits and cost
sharing to make it easy for employers and employees alike to make apples-to-apples
comparisons.
PCMI and its affiliates have more than 15 years of
experience providing employer-sponsored health benefit management services,
with a current client base of some 800 small employer groups in California and
Arizona.
The contract with PCMI will cost an estimated $50 million
over the three year term and includes the initial implementation of the
program’s administration functions and ongoing operating costs. PCMI will
provide eligibility, enrollment, marketing and fulfillment services, as well as
agent and general agent sales management, financial management and the small
business call center services.
“PCMI is thrilled to work with Covered California on this endeavor
and to be part of thishistoric change in health care. We are looking forward to
helping Covered California provide the services that will support employers and
their employees as they enroll in the health plans offered through Covered
California,” said David Zanze, President of PCMI.
Covered California will provide for health plan selection,
certification and ongoing management of plan relationships, lead marketing
efforts and provide policy guidance.
About Covered California
California was the first state to create a health benefit exchange
following the passage of federal health care reform. Covered California is
charged with creating a new insurance marketplace in which individuals and small
businesses can get access to health insurance. With coverage starting in 2014,
Covered California will help individuals compare and choose a health plan that
works best for their health needs and budget. Financial help will be available
from the federal government to help lower costs for people who qualify on a
sliding scale. Small businesses will be able to purchase competitively priced
health plans and offer their employees the ability to choose from an array of
plans and may qualify for federal tax credits.
Covered California is an independent part of the state government
whose only job is to make the new market work for California’s consumers, and
is overseen by a five member board appointed by the Governor and Legislature.
For more information on Covered California, please visit
www.CoveredCA.com.
