If you have CaliforniaChoice coverage, you’ve probably seen the name CHOICE Administrators on your benefits materials. But what exactly does a Third-Party Administrator (TPA) do and how is it different from your health insurance company?
Understanding the answer can make it easier to know where to go when you have questions about your benefits.
What Is a Third-Party Administrator?
A Third-Party Administrator, or TPA, is an organization that manages administrative functions related to employee benefits on behalf of an employer, health plan or other organization. Depending on the arrangement, a TPA may handle functions such as:
- Claims administration
- Billing and payment processing
- Customer service
- Provider-related services
- Enrollment and eligibility administration
- Other benefits administration activities
A TPA is different from the company that actually insures your health coverage. That distinction is important because the company administering your benefits isn’t necessarily the company providing the insurance. The Society of Professional Benefit Administrators reports that approximately 60% of American workers are enrolled in health plans managed by third-party administrators.
How a TPA Works with CaliforniaChoice
Here’s where it gets relevant to your CaliforniaChoice coverage. CHOICE Administrators is the Third-Party Administrator for the CaliforniaChoice private exchange. CaliforniaChoice itself is not a traditional health insurance company. Instead, it brings multiple health plans together in one employee-choice program, while CHOICE Administrators handles the administration of the exchange.
When you enroll in CaliforniaChoice, your health coverage is insured by one of the participating health plans.
- Anthem Blue Cross
- Health Net
- Kaiser Permanente
- Sharp Health Plan
- Sutter Health Plan
- UnitedHealthcare
- Western Health Advantage
In simple terms CHOICE Administrators administers the program. Your selected health plan provides your health insurance coverage.
Why Doesn’t Everyone Have the Same Health Plan Options?
One of the advantages of the CaliforniaChoice model is that it brings multiple health plans and coverage options together. However, the specific health plans available to your employees depend on factors such as where your business is located and where your employees live.
For example, a CaliforniaChoice group with employees throughout the state may have access to all seven participating health plans, depending on employee locations. A group headquartered in Los Angeles County may have access to a different selection of plans than a group based in San Diego or Sacramento. That’s because some CaliforniaChoice health plans operate statewide, while others serve specific regions.
Your broker can help you understand which health plans and coverage options are available to your group.
What Information Is on Your ID Card?
Your CaliforniaChoice ID card is designed to give you the information you need to access your health coverage. Depending on your plan, it identifies important information such as:
- Your health insurance company
- Member ID and group number
- Claims information
- Member service phone numbers
- Prescription drug information
- Other contact information you may need when accessing care
This is also why it’s important to look at your ID card when you have a question about your coverage. The health plan listed on your card is the company providing your insured benefits.
What If You Don’t Have Your ID Card?
Don’t worry if you don’t have your card handy. If you need to see a doctor and don’t have your ID card available, the provider’s office can contact CaliforniaChoice Customer Service to help confirm your coverage.
CaliforniaChoice Customer Service: 800.558.8003
Having your member information available can help make the process even easier.
Why Understanding Your TPA Matters
Knowing the difference between a TPA and an insurance company can make navigating your benefits a little less confusing. With CaliforniaChoice, you have a program that brings multiple health plans together, while CHOICE Administrators manages the administration behind the program.
That means you can have the convenience of one program and one place to manage your group benefits, while your employees still have the ability to select coverage from participating health plans based on the options you make available. When questions come up, knowing who does what can help you get to the right resource faster.
Have Questions About Your CaliforniaChoice Coverage?
Your employee benefits broker can help you understand how your CaliforniaChoice program works, including your available health plans, coverage options and renewal choices. If you have a question about your specific coverage, your ID card and CaliforniaChoice member resources are also good places to start.
If you’re interested in learning more about how CaliforniaChoice works, or you’re looking for a broker to help with your employee benefits, you can find a CaliforniaChoice broker online. The more you understand about how your benefits work, the easier it is to make the most of the coverage you already have.