OSCA Health Care Plan FAQ's
The following are some very common questions that people have about OSCA's Health Care Plan. Please see the Q&A below to get more details.
Q1. All I can afford now is a very high deductible (i.e. $6,000 - $10,000 for an individual) and there's no coverage at that level anyway because we're healthy.
- If you're stuck in a transitional relief product or Affordable Care Act (ACA) modified community rate plan, then the OSCA plan will allow you to obtain a quote for a non-modified community rate plan with nine different premium levels to consider. You may find rates available like they were before ACA and as much as 91% lower. The best way to know is to take a few minutes to complete the application so we may provide you the quote options.
Q2. Can I get different options, my grandfathered plan doesn't allow me to change plans?
- Yes, you may freely choose from among the nine different plans at nine different price points for whatever best fits your needs.
Q3. I have a transitional renewal and it's an OK rate, why would I want to change?
- There are a couple of reasons. According to the ACA, you will not be allowed to renew that plan past this final, terminal renewal. If you've managed to stay in a transitional relief plan then it means you're pretty healthy. Now is the time to move into the OSCA plan when the best rates are available to you. If you move over now you also have the ability to choose from nine plans, all ACA compliant, that offer a wider range of benefit/premium options that having to take the one option under Grandfathering. It only takes a few minutes to get your quote.
Q4. When may I enroll into the OSCA plan?
- At this time the open enrollment is for December 1, 2016 effective date. Future opportunities may be made, but that would not occur before April 1, 2017 and is subject to carrier and plan approval. You should take a few moments now to see where the rates fall, this could be a big deal.
Q5. How does the OSCA benefit?
- Providing tangible member benefits is important, and securing insurance options for DC's facing large premium increases and/or tax penalties is an important function for the association. Establishment of a plan that addresses these realities in 2016 is important. Whether you have experienced the impact of ACA or not due to a grandfathered opportunity, the reality is that this may be your only option to secure a legal alternative beyond next year and now is the time to participate. Additionally the OSCA has a small revenue to offset the administrative cost to establish and communicate benefits.
Q6. I have employees, but they aren't full-time and or they are covered through their spouses. I can't afford to pay for them just to obtain benefits they don't want.
- There's a few things to consider here. Under the individual mandate, there is a penalty for persons without insurance in each month of 2016. That penalty is up to 2.5% of adjusted gross income and is paid on each belly-button there is not coverage upon. You may have a key employee working 25 hours, who faced with the reality of a tax penalty, may move employment just to obtain benefits. That's happening in the real world. You may find premium options that are surprisingly low, and if as an employer you are required to pay for 50% of the premium you are in a position to include the employee for a reasonable monthly cost it addresses several concerns, avoidance of tax penalties, securing key employees, complying with the law, and having appropriate coverage in-place.
Q7. I don't have insurance, I'm healthy and I can get everything I need here at the office.
- Perhaps, but one thing has changed and that is there is now a tax penalty for not having coverage. An IRS tax penalty is not a deduction, it's a dollar-for-dollar penalty of tax over and above what you might already owe. These penalties will likely increase each year as they have done so the past three years. It suggests that the penalty will be more than the cost to purchase coverage and that's how you will comply with the individual mandate. Second, going cold turkey is fine except for those situations that aren't expected or anticipated, such as accidents, stroke, etc. where the claim is an unexpected event although conditions prior to the claim did not warrant a concern. Even if the coverage you elect is catastrophic, it's better to be in compliance now that there is a penalty and eliminate this possibility. If you establish an HSA for instance, then you may contribute pre-tax, and with Section 125 planning, the premiums may be deducted pre-tax, saving payroll taxes. Once you see what rate options are available it may be time to see just how little it might actually cost to participate in a plan.
Q8. We don't have two employees, it's just me.
- If you're married, then you may want to consider IRS Section105 planning to establish your spouse as a legal employee to be eligible. In so doing you could sponsor a plan that would cover yourself, your spouse and any dependent children you have up to age 26.
Q9. Who's a full-time employee if I decide to include others?
- The Dept of Labor does not establish what an employer defines as full-time, only that in whatever application the employer determines to define that there is not discrimination in the application. Under the employer shared mandate that may not actually apply to many DC's considering this, the IRS measures based upon 30 hours weekly or 130 hours monthly, whichever method you determine to use. There is no rule that precludes involving a part-time employee, for example, someone working 24 hours weekly, from having a benefit if you determine to offer it. This may make sense if the individual doesn't have access to affordable coverage and would consider leaving employment to obtain coverage or avoid a penalty. In a case where you need another person to form a group of two, once you evaluate the true net cost of coverage, it may be more affordable that you think to create a group of two.
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