Group Medical Insurance in California: Plans & Benefits

The largest provider networks in the nation – and in California. Popular plans with quality care at different price levels. Customize employee medical benefits that work best for your employees and your budget.

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Group Medical Plans for California

Explore Anthem's affordable, flexible group medical plans, including EmployeeElect and Consumer-Driven Health Plan (CDHP) choices. Our funding options and group health expense accounts offer even more ways for employees in large and small groups to save on health care costs.

Preferred Provider Organization (PPO)

PPO plans have large provider networks and give employees more choices than an HMO plan, but monthly premiums and deductibles are usually higher. No primary care physician (PCP) is needed. No referrals for other in-network doctors are required. Choosing doctors, hospitals and other covered medical services that are not in-network might cost employees more out-of-pocket.

Select PPO

Select PPO plans give employees access to the same high-quality providers as a PPO, but usually the network is smaller. The monthly premiums and deductible options offer greater value than the standard PPO. No PCP is needed and no referrals for other in-network doctors are required.

Health Maintenance Organization (HMO)

HMO plans offer network provider choices similar to a PPO, but members must select an in-network primary care physician (PCP) to coordinate their care. Referrals are needed to see other doctors. The monthly premiums and out-of-pocket medical costs are generally lower than other plans.

Select HMO

Select HMO plans work like a standard HMO, but usually the network is smaller. The monthly premiums and out-of-pocket costs are generally lower than most other plans, offering greater value than the standard HMO. Members must select a primary care physician (PCP) to coordinate their care. Referrals are needed to see other doctors.

Consumer-Driven Health Plans (CDHP)

Typically, CDHPs have lower premiums but higher deductibles (the amount members pay out-of-pocket for health services before the health plan pays). CDHPs are typically paired with a Health Savings Account (HSA). An HSA is a tax-exempt bank account, set up to help save for – and cover – qualified health care expenses and prescriptions (see below for more information on available health accounts). A CDHP combined with an HSA or other type of health account may also be called a high deductible health plan (HDHP).

Anthem Balanced Funding (ABF)

*Available in California for large groups and small groups with 50+ employees.

Gives businesses predictable monthly payments and a limit to their financial responsibility. Offers the flexibility of a self-funded plan, with money back if their claims experience is favorable.

Funding Options

*Available for large groups in California (100+ employees).

The most common type of alternative funding plan is the self-funded Administrative Services Only (ASO) plan. Fixed monthly costs for these options are significantly lower than fully insured plans, the financial risk is also greater. ASOs are recommended for large groups with the financial resources to tolerate fluctuations in monthly claims costs.

Anthem also offers Stop-Loss options that put a threshold on the maximum amount of annual claims costs paid by your business.

Help Employees Save More With a Group Health Expense Account

Anthem has a variety of flexible spending and health account options in California to fit your small or large business needs. Our seamless account management tools help make health spending decisions easier.

Health Savings Account (HSA)
Health Reimbursement Account (HRA)
Health Incentive Account (HIA)
Flexible Spending Account (FSA)

Health Savings Account (HSA)

A Health Savings Account (HSA) is a tax-deductible savings account that is owned and funded by the employee to help save for – and cover – qualified health care expenses and prescriptions. Like a bank account, HSA funds remain with the member, but can only be spent on health care expenses. Anthem can pair an HSA with an HDHP or CDHP to help cover out-of-pocket medical expenses, including prescription drugs. Like the HRA, employers can add funds to an HSA as a rewards program for employees who engage in healthy lifestyle choices.

Health Reimbursement Account (HRA)

A Health Reimbursement Account (HRA) is an employer-funded health savings account. Anthem can pair an HRA with a High Deductible Health Plan (HDHP) or Consumer-Driven Health Plan (CDHP) to help employees pay for covered costs. CDHPs often require employees to pay the deductible first, before the HRA account will reimburse additional health care costs. Employers can also add funds to the HRA to establish a rewards program for employees who engage in healthy lifestyle choices.

Health Incentive Account (HIA)

Health incentive accounts (HIA) are an effective large group plan strategy for addressing California’s rising health care costs while improving the health and productivity of employees. A consumer-driven program, employees earn money for their HIA by completing specific healthy behaviors and care engagement activities, then can use their HIA earnings to help pay for covered medical expenses and prescriptions. With an Anthem HIA, unused funds rollover year-to-year.

Flexible Spending Account (FSA)

A Flexible Spending Account (FSA) is an arrangement that employees set up with their employers, allowing them to set aside pre- tax money to pay various kinds of expenses, like co-insurance or child care, for example. An FSA can be paired with any plan. Anthem can set up an FSA that is directly integrated with medical claims processing, so employees are automatically reimbursed for eligible out-of-pocket expenses.

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