OSMA's New 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) plans to offer a new Health Benefits Plan (HBP). The OSMA HBP will be a self-funded multiple employer welfare arrangement developed for Ohio physician practices. The HBP is currently pending approval by the Ohio Department of Insurance. If approved, it would be an innovative alternative to the ACA.


How is the OSMA's new HPB different from the ACA?

Unlike the current ACA structure, the OSMA HBP

  • will be a self-funded plan for small physician practices,
  • will offer a variety of plan designs that meet the minimum essential coverage requirement, including
    • eight different options with deductibles ranging from $500 to $6,350 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.


Will my current plan rates go up under the ACA?

The ACA premium will be dependent on a variety of factors and specific to each group. Our in-house insurance agent will help you understand your options and will be in a position to help you get the most affordable benefit option available.


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).  


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.)


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

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


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.


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 preexisting condition exclusion.


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.


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 insured must be an active member of the Ohio State Medical Association.


Is the OSMA HBP permitted by the ACA?

Yes. The OSMA HBP is a self-funded option allowed under the ACA. The OSMA  Insurance Agency is authorized to offer health insurance plans as a Federally-facilitated Marketplace Certified agent and Certified Patient Protection and Affordable Care Act (PPACA) Professional.


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.


How secure is the OSMA's HBP?

The Ohio Department of Insurance and several federal government agencies coordinate the oversight and regulation of the OSMA HBP. This mufti 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.


Is there a situation when my practice should use the ACA's marketplace options?

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.