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OSMA’s Health Benefits Plan: Frequently Asked Questions & Answers

In response to the changes brought about by the Affordable Care Act (ACA), the Ohio State Medical Association (OSMA) created a new Health Benefits Plan (HBP). The OSMA HBP is a self-funded multiple employer welfare arrangement developed for Ohio healthcare providers.

 

1. How is the OSMA’s HPB different from the ACA?

  • Unlike the current ACA structure, the OSMA HBP
    • is a self-funded plan for small healthcare provider practices,
    • offers a variety of plan designs that meet the minimum essential coverage requirement, including
      • ten different options with deductibles ranging from $500 to $7,000 for single coverage (2x for family coverage) and
      • several plans with copays and prescription drug cards,
    • will allow for the continued use of Health Reimbursement Accounts (HRA) and Health Saving Accounts (HSA),
    • may be less expensive than many comparable options under the ACA,
    • will allow for changes in benefits and contribution rates at renewal without being “locked in” by the grandfathered status, and
    • no monthly administrative billing fee.

2. Do I have to switch doctors?

  • The OSMA HBP utilizes the SuperMed Plus network from Medical Mutual of Ohio, one of the largest networks of providers and facilities in the state. You should; however, always check to make sure your doctor is in network prior to any service (https://providersearch.medmutual.com/NetworkRealignment.aspx).

3. Does the OSMA HBP provide the employer with a Summary Plan Description (SPD)?

  • Yes. We provide each employer with an SPD for the OSMA HBP that meets ERISA compliance regulations. (All employers are responsible for providing SPD’s for all of their health and welfare benefits.)

4. What is the cost to me for joining the OSMA HBP?

  • In lieu of monthly insurance premiums each group will have a monthly funding rate based on a variety of factors including but not limited to:
    • Number of Covered Employees
    • Medical History
    • Gender
    • Age
    • Tobacco Usage
    • Location

5. Why should I change plans now?

  • Due to the constant policy evolution of the ACA and the uncertainty of future year premiums, many groups will be able to experience a competitive rate that may not be available from Ohio’s ACA Marketplace. The OSMA Insurance Agency will provide an easy to understand comparison between the ACA plans and the HBP.

6. If I leave my current plan (including an ACA plan) will I be subject to preexisting conditions limitations?

  • No. The coverage will be offered on a guarantee issue basis with no pre-existing condition exclusion.

7. What happens if I decide to leave the OSMA HBP in the future?

  • Members may elect to withdraw from participation in the Plan at the end of a calendar month by giving written notice to the Plan at least thirty (30) days prior to the end of such month.

8. Is there a fee to be part of the OSMA HBP Plan?

  • No. There is no fee to join the OSMA Health Benefit Plan but at least one Healthcare Provider in the practice must be an active member of the Ohio State Medical Association.

9. What is the OSMA Health Benefit Plan’s legal structure?

  • The OSMA HBP is technically known as a multiple employer welfare arrangement (MEWA). A MEWA provides health and welfare benefits to employees of two or more employers who pool their contributions, enabling them to offer health insurance rates and benefits typically available only to larger groups.
  • The Ohio Department of Insurance and several federal government agencies coordinate the oversight and regulation of the OSMA HBP. This multi-jurisdiction gives the State of Ohio’s Department of Insurance primary responsibility for overseeing the financial soundness the OSMA HBP, while the U.S. Department of Labor provides oversight for employee benefit plans and the Internal Revenue Service ensures the nonprofit tax status of the OSMA HBP.
  • In the unlikely event the OSMA HBP does not have sufficient funds to pay beneficiary claims; our reinsurer has contractually agreed to cover any unfunded beneficiary claims. This provision along with other reinsurance programs greatly reduces or eliminates a key risk of this arrangement.