HRA Proposal. Presented by O. C. A. B E N E F I T S E R V I C E S, L L C.

Transcription

1 HRA Proposal Presented by 2015 O. C. A. B E N E F I T S E R V I C E S, L L C.

2 In 1983 O.C.A. Benefit Services opened its doors with one goal; to help people. Since then O.C.A. has grown to a national TPA, servicing over 100,000 lives across the United States. O.C.A. Executive Summary For more than 30 years, O.C.A. Benefit Services, LLC (O.C.A.) has been a leader in the employee benefits arena with a commitment to customer service through creative and cost effective benefit plan designs. We are not just an administration company, but rather an Employee Benefits Delivery Organization established to provide employers, agents, brokers, and plan participants with the most cost effective and efficient benefit packages available. We believe that quality healthcare is actually less expensive to deliver than poor quality healthcare. While we recognize the very nature of human behavior is to resist change, we also need to embrace the reality that Consumer Empowered Health Plans (CEHP) are the cure to rising health care costs and poor quality health care delivery. Our approach is candid, open, and honest. We believe in setting fair and reasonable expectations with all the parties involved. We understand that keeping the process easy is critical to the implementation of the program, but we also understand that sacrificing compliance will eventually catch up with a client in direct or hidden costs. Our role is more than just a Third Party Administrator, but as a portal of reliable information and education so that the Plan Participant can once again be engaged as a consumer of health care. Dependents Broker O.C.A. Clients Employee Employer We thank you for your interest in learning more about our administrative services. Please do not hesitate to contact us with any questions. Sincerely, Stephen Honig President, O.C.A. Benefit Services

3 O.C.A. administrative services 1986 began offering FSAs. In 2004 we wrote our first HRA case. In 2007 we began offering COBRA, Wellness, & Parking/Transit administration. The Services We Offer... O.C.A. Benefit Services offers a complete suite of Administrative Services including: Plan Design Consultation, HRA Administration, Cafeteria Plan Administration (POP/FSA/DCAP), HSA Administration, COBRA/Retiree Billing Administration, Parking/Transit Administration, and Wellness. With any employee benefit program, plan design is the first, and probably the most important step in creating an effective program. Each worksite situation is unique, so the key is to design a plan to achieve your specific goals. HRA FSA COBRA Parking/Transit Wellness HSA In the United States, the problem is not with the cost of health insurance. The problem is with the cost of health care. Until we control the cost of care, we will never gain control over the cost of the insurance.

4 In 2012, O.C.A. s HRA Client Utilization ran at 31%. Out of 29 million dollars in HRA Employer liability, O.C.A. paid out only $9 million. This is 20% below industry average, which we feel is tied to are employee education and compliant claim adjudication. What does O.C.A. stand for? Organize Commuicate Achieve O.C.A. s HRA Administration... HRAs can vary greatly in design, but are developed basically for the same purpose to reimburse the employee for expenses not covered by any other health plan. For example, one HRA can be designed to cover all or a portion of the deductible on a High Deductible Health Plan (HDHP), while another is designed to reimburse the employee for dental and vision expenses. It just depends on the employer's goals for providing employee benefits. While an HRA can be tailored to any health care coverage, the most effective approach involves the traditional High Deductible Health Coverage (HDHC). Employer HRA Advantages... An HRA's flexibility allows the employer to create practically unlimited plan design, from the simplest to the most complex. With O.C.A., employers can design a single-value HRA with multiple benefit designs and options (medical, dental, vision, wellness through our HERO program, etc.), differentiated deductibles, coinsurance rates and co-pays for each benefit option, variable employee/employer responsibility, and roll-over, all customizable by plan. An HRA gives employers choices and greater control over healthcare costs. It provides employees with financial assistance when they incur eligible covered expenses.

5 Did you know that under an HRA, self-employed individuals (e.g., sole proprietors, LLC, partners in a partnership, and greater-than 2% as shareholder (and direct family members) may not receive tax free benefits? This is due to the ownership attributions rules under IRS Code 318. Why Choose O.C.A.? Creative Plan Design Choices: Nearly limitless plan designs, including embedded deductibles, differentiated co-pays, donut holes and variable employee/employer responsibility. Preparation of HRA Legal Documents: O.C.A. will create a customized plan document outlining the provisions of an employee benefit plan. Annual 105(h) Non-Discrimination Testing (Upon Request): Annual discrimination tests are designed to show that eligibility and plan benefits are applied fairly and consistently, which in turn allows the plan sponsor to avoid unfavorable tax consequences Customized Employee Communication Material: Whether it s a group of two or a group of five thousand, O.C.A. will create customized employee communication material based upon the groups plan design. O.C.A. provides industry expertise with top of the line representation. We represent our clients by educating and assisting employers, employees and their families. Client Customer Service: We are committed to our client relationships and it shows from the effort we put forth that our clients needs are professionally, courteously and personably satisfied. The member service department is open from 9:00 am to 5:00 pm Eastern time Monday through Thursday and until 4:30 pm Eastern time on Friday. O.C.A. also provides members 24/7 access to account balances through our website, 24/7 access thru our Interactive Voice Recognition Phone System (IVR) as well as a mobile application on the Android and iphone. Annual PCORI Fee Reporting: Health Reimbursement Arrangements (HRAs) are considered self-insured plans and thus subject to the Patient-Centered Outcomes Research Institute (PCORI) fee. O.C.A. assists the employer in calculating this fee each year. To learn more about PCORI, visit Direct Deposit of claim payments: Direct deposit of employee claims is efficient, environmentally friendly, and saves money. Imagine submitting a claim to O.C.A. Benefit Services at 9:00 a.m. and having that claim processed either the same day or at the latest, the next business day. Once processed, the funds hit the Federal Clearing House. Once cleared, it will then hit your bank to clear for deposit. You are then free to access those funds to pay your provider for the services that were rendered. For an additional small fee, O.C.A. will pay providers directly on the employee s behalf.

6 In 2007, the IIAS Standards Interest Group incorporated as SIGIS: Special Interest Group for IIAS Standards. And in January 2008, the SIGIS standard was launched, enabling merchants to meet the new IRS requirements. SIGIS also initiated a merchant certification for support of its IIAS Standard and made the SIGIS Eligible Product List available for use by Member merchants and benefit plan administrators. Electronic Payment Card O.C.A. s mysource MasterCard debit card provides account holder convenience with single-source access to HRA, FSA, and HSA dollars and expedites claim processing through industry standard autoadjudication parameters. Electronic payment cards are becoming more prevalent and vital in a successful benefit plan offering. Introducing an electronic payment card into a reimbursement account plan empowers employees and gives them an option to avoid inconvenient out-of-pocket expenses. Do you know about the E-Zcard it s O.C.A. s advanced healthcare debit card that will allow employees to pay for certain qualified I.R.S. expenses at employer determined percentage payouts, defined co-pay amounts, and much more! E-Zcard allows for employee "skin in the game" to help motivate behavior and control costs. I.R.S. Regulations Pertaining to Health Debit Cards The Federal government requires certain debit card transactions be substantiated via the submission of necessary supporting documentation that supports the charge. If supporting documents are not provided (typically within 30 days of the swipe), these regulations require the card be timed-out (temporarily suspending the use of the card) until said documents have been provided to O.C.A. There are claims that will auto substantiate without the need for submitting documentation and want to identify those rules to eliminate confusion and frustration. O.C.A s mysource Debit card will work and auto-substantiate at vendors (i.e. CVS, Walgreens, RiteAid, etc.) that have gone through a certification process (referred as I.I.A.S.). This certification process itemizes expenses as deemed eligible under IRS Code 213(d), which is the complete list of FSA approved expenses. It is also important to know that mysource Debit Cards are also able to be used at merchants such as doctor s office, dentist, optometrist, hospital, and others. However, these approved locations (merchants) were exempt from the same requirements that govern the certification process that the vendors went through (IIAS). That said, using the mysource Debit Card at these locations will almost (with few exceptions) always require supporting documentation be submitted.

7 O.C.A. offers myrsc mobile application! Our mobile app is available on the iphone or Android based phone. Employee s can view account information, manage their HRA benefit, and even submit a claim using our SnapClaim feature! myrsc Online Access Employers and their employees will have 24/7 access to our secure web portal called myrsc (My Resource Service Center). myrsc provides each user a customizable view based on whether the user is the employee, or human resource administrator,. Employer will have the ability to access HRA distribution/contribution reports, employee account balances, payment history, and much more! The single most distinctive characteristic of the site is its adaptability and its ability to fit the purpose of any user. myrsc Mobile Access Employees can now access their benefit account information on their Smartphone with the Mobile myrsc app for iphone and Android. Simply search for myrsc on the App Store for Apple products or on the Google Play Store for Android products, and then load as you would any other app. Participants have access to: Account balance information Debit card transaction history File a claim and upload receipt photos via the SnapClaim feature! Our HRA solution offers maximum flexibility for virtually unlimited plan design capability, plus 24/7 online account information via myrsc.com/mobile myrsc, and linked mysourcecard debit card.

8 O.C.A. has positioned itself at the forefront of HRA administrators by partnering with Trotter Wellness and their new wellness platform Well Nation. This new partnership will bring a new approach to the combination of wellness and account based benefit solutions. Healthier Employee Reimbursement Option What do you get when you tie O.C.A. s Health Reimbursement Arrangement (HRA) with a wellness program? O.C.A s Healthier Employee Reimbursement Option (HERO)! O.C.A. s H.E.R.O. Program allows employers to offer the HRA reimbursement, but also engage employees in a state of the art, comprehensive wellness incentive program. Through our partnership with Trotter Wellness, O.C.A can now interconnect wellness into the account based benefit programs better than ever before! The result is a happier, healthier, and more productive employee! Changing Behavior How Does H.E.R.O. Work Employer selects Medical Plan (HDHP recommended) and offers a Health Reimbursement Arrangement (HRA) in conjunction with the O.C.A. H.E.R.O. Program. The example program would then work as follows: HDHP medical plan deductible is $2,000/$4,000 Employer HRA reimbursement is $1,000/$2,000 Employer H.E.R.O. points available is $1,000/$2,000 By implementing H.E.R.O., the employee can complete different wellness activities (I.e. Health Risk Assessments, taking a physical, biometric screening, health coaching, and more!) and accumulate wellness points. Those points can convert into additional HRA dollars. By accumulating points, employees can an earn an additional $1,000/$2,000 in HRA funds, thus leaving the employee with a $0 deductible.

9 O.C.A. s education & compliance programs have a direct impact on your claim utilization. We feel our administration costs are the lowest in the industry. Requested Quote for HRA Administration Services Annual Fee Rate PPPM HRA $500 $8.00 FSA Included at No Additional cost $50 Monthly Minimum Additional Service Fees May Apply Paper Check Reimbursement $1.00 Per Check Issued Pay Provider Option $2.00 Per Check H.E.R.O Program Contact O.C.A. for Additional information For additional information please contact: O.C.A. Benefit Services Sales Department (609) or sales@oca125.com