Why did my office receive IRS Forms 1094-B and 1095-B from the ODA Wellness Trust?
In an effort to assist employers with their Patient Protection and Affordable Care Act (PPACA) reporting responsibilities, The ODA Wellness Trust (ODAWT) provided IRS Forms regarding your health plan. The information on the forms will assist your employees and the IRS to establish they have met their individual mandate to maintain minimum essential health coverage. Forms were mailed to each employer during the last week in Jan 2017.
Please click here for additional information on:
- What do I do if there is incorrect information on the Form?
- What do I do with the IRS From 1094-B?
- What am I required to do with the IRS Form 1095-B?
- What if my form does not indicate coverage for all 12 months?
When can I enroll in the plan?
There are two times you can enroll to an existing ODAWT employer plan. The ODA Wellness Trust holds an annual renewal in the fall when new offices and employees may join the Trust to be effective January1. Annual renewal is held in October. Alternatively, if you have a qualifying event, such as loss of your current insurance coverage, you may enroll within 60 days of the date of the event.
What is a qualifying event?
A qualifying event is a life-change that makes you eligible within 60 days of the event to change your health insurance coverage outside the annual enrollment period. Life changes might include a marriage, birth, adoption, death, divorce, loss of coverage due to reduction in work hours, loss of job, relocation, or loss of student insurance or Medicaid. It is not a voluntary loss of coverage or due to non-payment. Proof of qualifying event is required to be submitted at the time of application. Please click here for a list of acceptable events and the required documentation.
How do I request termination of an ODAWT enrollee?
An employer wishing to remove an employee or an enrollee who no longer wishes to continue coverage needs to notify ODA Wellness Trust in writing prior to the requested termination date. The termination request may be submitted via email to firstname.lastname@example.org or by fax to (614) 340-9444. You will receive confirmation that the termination was received and is being processed.
How do I request a dependent change under ODAWT?
Changes regarding a dependent require a change application to be completed with the updated information and must coincide with a qualifying event(if adding). A request to add a newborn as of their date of birth must be received within 30 days of the date of birth. A plan/deductible change may only be made during annual renewal. Please contact us at 1-800-282-1526 or by email at email@example.com for further assistance.
What health plans are available for dentists and their staffs through the ODA?
The ODA Wellness Trust is your solution. Ohio Dental Association member dentists can enroll in the ODA Wellness Trust to receive high quality health benefits for them and their staffs at affordable rates.
The ODA Wellness Trust is a private, dentist owned, self-funded, employer health benefit plan. It was exclusively developed by member dentists for member dentists and their staffs to help battle the increasing cost of providing health care benefits. It offers traditional benefit plans with six different deductible levels and Heath Savings Account plans. To review our plans, click here.
What’s the advantage to going through the ODA for my health coverage?
The ODA Wellness Trust was designed to save member dentists money. It is unique and only available to ODA members and their staffs. Because the ODA Wellness Trust is a self-insured plan, it has many benefits, including the ability to design plan and deductible options, choose networks and features, and keep costs low by avoiding the state insurance premium tax and many of the ACA’s mandated taxes. For details on how we can save you money, contact us at 800-282-1526 or firstname.lastname@example.org.
Why offer an employer plan?
Group health plans – like the ODA Wellness Trust – purchased through a payroll deduction can be paid with pre-tax dollars. The employee gets a tax break on the premiums of a least 15 percent. By paying for health insurance with pre-tax dollars, the employee does not pay federal, state or social security taxes on the cost of his or her insurance. This is beneficial to employees instead of paying for individual health insurance with after tax dollars, even if the employer chooses not to make any contribution to the cost of the plan. The employer saves the social security matching tax too.
What are the advantages of a self-insured plan?
There are several reasons why ODASC chose the self-insurance option:
- The ability to customize the plan to meet the specific health care needs of member dentists as opposed to purchasing a “one-size-fits-all” insurance policy.
- The shareholders maintain control over the health plan reserves, enabling maximization of interest income – income that would be otherwise generated by an insurance carrier through the investment of premium dollars.
- The Wellness Trust does not have to pre-pay for coverage, saving members money.
- The ODA Wellness Trust is not subject to conflicting state health insurance regulations/benefit mandates, as self-insured health plans are regulated under federal law (ERISA).
- The ODA Wellness Trust is not subject to state health insurance premium taxes, which are generally 2 to 3% of the premium's dollar value, an additional savings for members.
- The ODA Wellness Trust is free to contract with the providers or provider network best suited to meet the health care needs of member dentists and their employees.
What are the liabilities of a self-insured plan?
Because the ODA Wellness Trust is a self-insured plan, the benefits are not guaranteed by a licensed insurer and are not covered by the Ohio Life and Health Guaranty Association. In the event that the multiple employer self-insured health plan is unable to pay its obligations, participating employers shall be required to contribute on a joint and several basis the funds necessary to meet any unpaid obligations. To mitigate this risk, the ODA Wellness Trust purchased a stop-loss insurance policy to protect the Wellness Trust assets against losses above a certain threshold.
Does everyone in the office have to participate in this plan?
No, they do not. All eligible, full time employees must be offered the opportunity to participate, but if they do not want to participate they simply sign a waiver form declining to participate.
Can an employer deduct the staff’s portion of the health policy from their paycheck?
Yes. Group health plans – like the ODA Wellness Trust – purchased through a payroll deduction can be paid with pre-tax dollars. The employee gets a tax break on the premiums of at least 15 percent. By paying for health insurance with pre-tax dollars, the employee does not pay federal, state or social security taxes on the cost of their insurance. This is beneficial to employees instead of paying for individual health insurance with after tax dollars even if the employer chooses not to make any contribution to the cost of the plan. The employer saves the social security matching tax too.
How will I be billed?
Payment of health care fees will be required monthly. Bills will be mailed out on or about the 15th of the month prior to the billing month and remittance will be due on the 1st of every month.
Payments can be mailed to ODA Wellness Trust, P.O. Box 932851 Cleveland, OH 44193 or monthly payments can be withdrawn automatically from your bank account. Only one electronic funds transfer can be established per office and must be for the entire amount of the invoice. Complete the automatic withdraw form and mail it to Medical Mutual of Ohio, P.O. Box 943 Toledo, OH 43656 or fax to (419) 473-7285.
Can I use my credit card to pay the premiums?
No, the Wellness Trust does not accept credit cards in order to save the members the cost banks charge to use the cards. You are able to have your Ohio Dental Association Wellness Trust Health Plan monthly payments withdrawn automatically from your bank account. Only one electronic funds transfer can be established per office and must be for the entire amount of the invoice. Complete the automatic withdraw form and mail it to Medical Mutual of Ohio, P.O. Box 943 Toledo, OH 43656 or fax to (419) 473-7285.
What if I have trouble completing the paperwork or don’t understand the plan(s) offered?
The ODASC staff is available to offer assistance and can be reached by phone at 800-282-1526 or by email at email@example.com. ODASC representatives are licensed insurance agents and can walk you through the various options available. They do not receive a commission on sales, so you can be assured they have your best interest at heart.
What if my employer doesn’t want to offer an employer plan – can I still get coverage?
Yes, we can help you secure individual coverage through an Off Marketplace plan. These plans are not through the government website, but through private companies. We can provide you with multiple quotes from different companies and also help you enroll. Learn more here.
How many hours do I have to work to be eligible for the Wellness Trust?
Each dentist determines the number of hours (between 25 and 30 per week) that employees must work to qualify for their employer health plan. Please click here for Employee Definitions.
How can I know if my doctor accepts this health care plan?
Please check our provider directory to see which health care plan lists your current doctor.
I have insurance through my husband’s employer, so I don’t need my employer’s coverage. Can I just waive my employer’s coverage if they let me work full time?
Yes. The individual shared responsibility provision requires you to maintain coverage, but as long as you remain covered by your husband’s policy, you’re complying with the requirement and won’t be subject to any penalty.
If you work full time and become eligible for your employer’s coverage, you can waive it and keep your existing coverage, and nobody gets penalized. Be aware, however, that some companies have started charging more to cover employees’ spouses who have access to their own employer-sponsored plans. So double check the details with your employer and your husband’s.
Do these plans comply with the Affordable Care Act (ACA)?
Yes. The ODA Wellness Trust covers the same set of Essential Health Benefits as mandated in the ACA with the exception of pediatric dentistry. Members who provide pediatric dental services to their family members can apply for a waiver of the pediatric dentistry requirement if they desire to do so.
The essential health benefits include:
• Ambulatory patient services
• Emergency services
• Maternity and newborn care
• Mental health and substance abuse disorder services
• Prescription drugs
• Laboratory services
• Preventive and wellness services
• Pediatric services
• Rehabilitative and habilitative services and devices
Renewal InformationThe ODA Wellness Trust is now in its second plan renewal, and 2017 plan renewal information has been mailed to all participating offices. Please watch your mailbox for these renewals.