Guaranteed issue: a carrier must fairly and affirmatively offer and sell its small employer plans to all small employers in the regions it serves. It may not reject an employer that offers coverage to all eligible employees and agrees to pay the premiums, however sick an employee is, and it may not require a health questionnaire before enrollment (§10753.05(b)(1), (g), (j)(2)).

No steering: a carrier, agent or broker may not encourage or direct a small employer to seek coverage from another carrier because of the health status or claims experience of its employees (§10753.05(h)). A written explanation does not make it acceptable.

Small business health care tax credit (federal): for an employer with 25 or fewer full-time equivalent employees and average wages under an inflation-adjusted limit, that pays at least 50% of employee-only premiums and buys a qualified health plan through a SHOP Marketplace. In California, that means Covered California for Small Business (CCSB). Coverage bought from an insurer off the Exchange does not support the credit.

QSEHRA (Qualified Small Employer Health Reimbursement Arrangement): for an employer that is not an applicable large employer and offers no group health plan to any employee. It is funded solely by the employer, with no salary reductions, and pays only after the employee shows proof of health coverage. It must be offered on the same terms to all eligible employees; amounts may differ only with the price of individual coverage based on age or family size.

ICHRA (Individual Coverage HRA): not limited to small employers. Participants must be enrolled in individual health insurance or Medicare. An employer may not offer the same class of employees both an ICHRA and a traditional group plan, so no employee in that class can choose between them. HealthCare.gov now calls ICHRAs CHOICE Arrangements.