OHIO FARM BUREAU HEALTH BENEFITS PLAN

Transcription

1 OHIO FARM BUREAU HEALTH BENEFITS PLAN PRODUCER GUIDE HEALTH benefits PLAN

2 TABLE OF CONTENTS OHIO FARM BUREAU HEALTH BENEFITS PLAN 3 UNDERWRITING GUIDELINES 4 SPECIAL UNDERWRITING TOPICS 7 QUOTING PROCESS AND CASE SUBMISSION 10 BENEFIT PLAN OFFERINGS 11 GENERAL ADMINISTRATION 13 APPENDIX 17 OFB HEALTH BENEFITS PLAN PARTICIPATING EMPLOYER COMPLIANCE GUIDE 19 OFB HBP QUALIFYING SIC/NAICS INDUSTRY CODES 27

3 OHIO FARM BUREAU HEALTH BENEFITS PLAN The Ohio Farm Bureau Health Benefits Plan ( OFB HBP ) is a unique self-funded health benefit option offered through Ohio Farm Bureau. 1. OFB HBP ( Plan ) is a multiple employer welfare arrangement that is administered by Medical Mutual Services. 2. The plan is backed by the health plan with reinsurance protection including protection for groups and participants in the event the plan should not have adequate funding to cover benefits. 3. The plan has received a certificate of authority to operate from the Ohio Department of Insurance. 4. It is governed by trustees who are Ohio Farm Bureau members, and by-laws that satisfy Ohio law. 5. The plan is available to sole proprietors and employer groups with up to 99 eligible employee lifes based in Ohio and operating in the agriculture economic sector. 6. Eligible employees are required to be members of the Ohio Farm Bureau Federation. The plan offers: 1. A broad range of products covering what the Affordable Care Act refers to as platinum to bronze benefit levels. 2. Competitive rates. 3. Predictable, fixed monthly payments. 4. The protection of being a part of a larger self-funded pool of participants under the governance of plan trustees. 5. Medical Mutual network and claims administration. This OFB HBP Producer s Guide covers many important details that you need to know when discussing this alternative with your small group clients. It will answer many of your questions regarding underwriting, quoting, plan option and administrative guidelines. In the event of a discrepancy between this guide and any plan agreement or contract as it relates to the plan, the terms of the agreement or contract will prevail. 3

4 OHIO FARM BUREAU HEALTH BENEFITS PLAN PRODUCER GUIDE UNDERWRITING GUIDELINES The OFB HBP uses the following underwriting regulations in order to determine employer and employee eligibility for benefits. These requirements are effective with the employer s participation effective date. It is important that you read this guide and understand the requirements. If the participation requirements are not met, the participating employer may be cancelled by the OFB HBP as outlined in the Participation Agreement. The OFB HBP reserves the right to exercise discretion in the application and coordination of the underwriting guidelines. WHO IS ELIGIBLE? A. Which employers are eligible to participate? An eligible employer is defined as a business or other legal entity that is actively engaged in a full-time enterprise that has the legal capacity to sponsor a group health benefit plan on behalf of one or more common law employees with an employer and employee relationship. 1. Entity types. The employer must be a corporation, limited liability company, partnership or proprietorship. Non-profit entities are permitted. 2. Agriculture economic sector. The employer must be engaged in the commerce of agriculture in the state of Ohio. This is determined by operating in the business codes contained in the list of participation industry codes or by the plan trustees. 4

5 3. Employer status. An employer-employee relationship exists. Sole proprietors actively at work with at least one non-family member eligible employee count in this plan. 4. Permanent operation. The employer s operations must be permanent in nature. 5. Employee requirements. The employer must employ at least one and no more than 99 eligible employees during the preceding calendar year and have at least one enrolled employee on the first day of the plan year. 6. Ohio domicile and operation. The employer must be domiciled in Ohio with a headquarters or an entity that is able to enter a contract in the state of Ohio. 7. Employees are OFB members. Employees must be Ohio Farm Bureau Federation members. Dues are billed at the same time the plan funding is billed. OFB membership dues are remitted directly to OFB by the health plan. 8. Sign a participation agreement. Employers are eligible if they sign a participation agreement and agree to comply with the requirements, rules and procedures of the plan. 9. HIPPA defined group. An employer meeting the requirements of section b,c,m, or o of Section 414 of the Internal Revenue Code ( common control sections) will be considered one employer. B. Who are eligible employees? hour rule. Employees must work on average 30 hours a week or more. Vacations and short-term disabilities do not count. 2. Meet probationary requirements. The employer establishes waiting periods of 0, 30, 60, or 90 days before eligibility or the first billing after 0, 30, 60, or 90 days of employment and are considered eligible employees. 3. Paid on W-2s or owners/partners. Eligible employees must be paid on W-2 or be full-time owners/partners. 4. Social Security number. Eligible employees must possess a valid Social Security number. 5. Present on government payroll forms. Eligible employees must be reported on state and federal payroll returns or in the case of owners schedule k1, F, or C. 6. Actively at work. Eligible employees must be actively at work. Short-term disabilities greater than 90 days result in a lack of eligibility requirement. 7. Ohio Farm Bureau members. Eligible employees must be OFB members. The employer promises to pay OFB dues with Plan Premium Equivalent Rate funding invoices. 5

6 C. Who are eligible dependents? 1. Spouse. Employee spouse as recognized under the laws of Ohio or where the employee lives. 2. Children. Employee or employee spouse s children including natural children, stepchildren, newborn, legally adopted and other children whom the employer has determined are covered under a Qualified Medical Support Order as defined by ERISA or any applicable law. Children are covered until the age limit listed on schedule of benefits. 3. Guardianship. Children of whom the employee or employee spouse are legal guardians. 4. Domestic partners. Individuals maintaining common residency and a committed economic relationship for over 6 months may be covered as domestic partners. D. Who are ineligible employees? 1. Ineligibles. Employees that do not meet an eligibility requirement hour rule failure. Employees that do not meet the 30 hour rule. 3. Temporary employees. Employees who have not worked over a year. 4. Seasonal employees. Employees that do not work over nine months a year and do not meet the requirements for eligibility under the rules of the Affordable Care Act for applicable large employers are considered seasonal. 5. Absentee employees. Employees absent from work and off payroll due to non-medical reasons. 6. Former employees. Former employees not covered under state or federal continuation programs contractors paid contractors unless they: i. Work at least 30 hours. ii. Employer contribution is same as employee. iii. Employer doesn t discriminate among 1099 contractors. iv. Contractor works exclusively for employer and at least 50% of employer is paid by W-2 and a minimum of two W-2 employees are enrolled. 8. Retirees. 9. Late enrollees. A late enrollee is someone who applies for benefits no more than 30 days after they are eligible or more than 30 days after the end of the waiting period. An enrollee is not late if at the time of enrollment the application is made within 31 days of a HIPPA special enrollment period. 6

7 SPECIAL UNDERWRITING TOPICS A. Segmenting. An employer may not segment employees into different classes for purposes of offering benefit plans. B. 75% net eligibility rule. 75% of net eligible employees with at least two employees if there are two or more employees otherwise eligible. The plan will exclude any employee who waives benefit coverage ( qualified waivers ) for the following reasons: 1. Covered by a spouse s health benefit plan. 2. Covered under a parent s plan up to age Covered by Medicare or Medicaid. 4. Enrolled in individual Medicare Supplemental plan. 5. Enrolled in government sponsored plan such as a low-income plan, TriCare, Medicaid, Veteran s Administration, Federal Employee Program, Railroad or other government administered plan. 6. Enrolled in an individual on or off exchange program. 7. Covered under a prior employer s retiree plan. 8. Coverage through a second active employer plan. 9. A member of a recognized religion that opposes health insurance. 7

8 C. 25%/50% minimum contribution rule. The minimum employer contribution is at least: 1. 25% of the total cost for health benefits chosen in the event the employer offers employee and dependent coverage % of the total cost for health benefits chosen in the event the employer offers single only. 3. OFB HBP recommends the employers chose fixed contribution amounts (not percentages) for each contract type. Many employers choose single and other contract (family) rates. D. Multiple product offerings. A participating employer may offer up to two benefit designs for eligible employees with under 10 eligible employees and three benefit designs for eligible employees over 10 employees. E. Waiting periods. Waiting periods of 30 days or first billing after 30 days worked. A standard waiting period facilitates compliance with regulatory requirements. F. Effective dates. 1. The earliest effective date is the date all new case submission requirements are received by the health plan s underwriting department. A future effective date cannot exceed 90 days from the date the applications are submitted or 60 days from the date the employer s paperwork is submitted. (For the plan start up date, the time periods are increased to 120 days and 90 days.) 2. Effective dates will be the first of the month. 3. Retroactive adds will be processed for up to 30 calendar days after the first of the month if a binder check has been processed. No guarantee of ID card delivery can be made. 4. Employers are encouraged to maintain in-force coverage until the OFB HBP enrollment has been finalized. G. Medical underwriting. 1. Enrollment applications must be completed and signed (electronically or on paper), including those waiving benefits or not completing their waiting periods. 2. Full medical information is required for all applicants. 3. If 50% or more of total eligible employees are enrolling, no health statements are required for waivers. 8

9 4. Employees must complete health statements for dependents. 5. Information needs to be complete, so additional questions may be required. H. Open enrollment 1. Employees may make changes to benefit plans during open enrollment. 2. Open enrollment is 31 days before and/or after the annual renewal date. The effective date would the annual renewal date of January Applications received outside of open enrollment will be considered late entrants. Unless the late entrant experienced a qualifying event, the next open enrollment period would be the opportunity for enrollment in the plan. I. Producer/sub-producer appointment a. Only appointed producers may distribute the OFB HBP. b. All producers must be approved by OFB HBP trustees or their designee. c. Sub-producers must be approved by the OFB HBP trustees or their designee. Producers must submit a request to approve a sub-producer to the plan administrator. d. Producers must be appointed by the ancillary carriers recommended by the OFB HBP trustees in order to receive quotations for group and individual ancillary products. e. Producers are appointed with the understanding they may enter manually completed applications as long as they attach copies of the applications in the FormFire system. 9

10 QUOTE PROCESS AND CASE SUBMISSION A. FormFire. The plan will utilize FormFire for gathering employer and employee data and the completion of forms. FormFire will provide the electronic platform for obtaining quotes and processing enrollment. FormFire will also provide many compliance features. B. Quote process. 1. Preferred rate. A producer may request a tier 1 rate upon the presentation of a census along with the desired health benefit plan. The health plan will provide a preferred rate quote. 2. Underwritten rate. The following items are required to prepare an underwritten rate. i. FormFire formatted census. ii. Employee health statements. iii. Current invoice. If the group is self-funded, the claims experience, funding rates, administrative and stop loss billing and fully insured equivalent rates. The renewal date for the current year should be included. iv. Renewal notice. If the group is within 60 days of its renewal date, the renewal should be included with the current invoice. C. Sold case submission process. 1. OFB HBP employer application. 2. OFB HBP signed participation agreement. 3. OFB HBP plan documents. 4. OFB HBP employee applications. 5. OFBF membership application. 6. Census (generated by FormFire). 7. Census reconciliation FormFire format. 8. Recent quarterly wage and tax statement supporting census reconciliation or proof of self-employment (e.g. most recent schedule C or schedule F). 9. Binder check if the effective date is within 30 days after the sold case submission date. 10. Signed rate acknowledgement. 11. EFT authorization, if used. 10

11 BENEFIT PLAN OFFERINGS A. Medical plans. 1. Plan 501. The OFB HBP offers plan number 501 as the self-funded MEWA option. An HRA can be linked to the plan if it qualifies as a high deductible health plan. 2. The OFB HBP offers eight major medical health plan designs including four high deductible health plans. B. Group ancillary benefits. The OFB HBP has made arrangements to offer fully insured group dental, vision, life, and short-term disability for participating employers. These products will be offered by the insurance carrier and are not a part of the OFB HBP. 1. The plan number is 502. The OFB HBP provides for group ancillary coverages along with the production of a summary plan description that is coordinated with the OFB HBP self-funded plan. Participating employers not using the OFB HBP facilitated options will be responsible for the preparation of their own summary plan descriptions. 2. The ancillary carriers will bill the group directly. 3. The carriers will pay the producer directly. 4. Participating employers will benefit by using the fully insured ancillary options. The use of these ancillary products will increase the value of these programs to participating employers in the future. Producers are encouraged, but not required, to offer the ancillary packages recommended by the OFB HBP. 11

12 5. The FormFire platform will be configured to facilitate administration of these plans. 6. Standard group ancillary packages will be quoted with elected benefit plan offerings. C. Work-site or individual benefits. The OFB HBP has made arrangements to offer critical illness, accident and disability benefits on an individual basis. Sole proprietors are eligible to enroll. These benefits will be offered on a fully insured basis. 1. The ancillary carriers will bill the group directly using list bill, or the individual. 2. The carriers will pay the producer directly. 3. Participating employers will benefit by using the fully insured ancillary options through the aggregation of volume and experience in the ancillary benefits. The FormFire platform will be configured to facilitate administration of these plans. 4. The producer may use the standard product recommendations and a FormFire produced census in order to quote and install these products. 5. These products are offered to all employees including individual sole proprietors and are not underwritten by industry code or group size as it is an individual product. D. Alternative markets. The OFB HBP recognizes the producers may have existing distribution arrangements for alternative markets including ACA individual and group policies and senior Medicare Advantage and Medicare Supplement plans. Medical Mutual and the health plan offer some products for these markets. The OFB HBP has not arranged for preferred products for these markets. 12

13 GENERAL ADMINISTRATION A. Plan billing. The health plan will bill the participating employer a premium equivalent rate on behalf of the OFB HBP. EFT is the preferred method of payment. EFT allows for the latest payment of cash. The health plan will initiate the demand debit transaction on the invoice due date; however, if the invoice due date falls on either a banking holiday, Saturday or Sunday, the withdrawal will be made on the next day. The participating employer receives a notice with the invoice stating that if payment is not made by the invoice due date, they will be placed on claims hold effective for the first of the month for which the payment was not received. B. OFBF membership dues billing. Membership dues will be billed at the same time, but on a different invoice. The OFB member dues are $6 per family per month. Members will become a member of their county as well as state (OFB) and national Farm Bureau. C. Delinquency process. If a participating employer fails to pay their premium equivalent rate, they will receive a termination/reinstatement letter. The participating employer will have five business days to pay the premium equivalent rate, or they will be terminated as of the first of the month for which the payment was not received. A late fee of $25 will be assessed. D. Employer terminations. Termination letters must be on letterhead from the participating employer and submitted to the health plan for processing 30 days before the termination date. Terminations are processed as of the month end. There are no refunds of funding paid if the termination letter is received after the first of the month of the coverage period. E. New hires and dependent status changes. 1. Applications for new hires and dependent changes must be submitted to the health plan within 31 days of the employee s eligibility date. 2. Special enrollment event applications should be submitted within 31 days of the qualifying event date. Special enrollment qualifications are marriage, birth, adoption, loss of coverage or other HIPPA special enrollment events. 3. An employee can request to terminate a dependent anytime. Terminations will be effective at the end of the month in which the status change occurs. 13

14 F. Continuation of benefits. 1. OFB HBP has contracted with a COBRA administrator who administrates the process. 2. The Census Reconciliation calculates the COBRA requirement for COBRA eligibility. Special rules are required for the calculation of the COBRA 20 employee rule. COBRA employee rules require 20 or more full-time equivalents on more than 50 percent of typical business days in the previous calendar year. Full-time equivalents are based on the percentage of actual hours worked up to 30 hours a week. The calculation is valid for the entire year based upon the calculation done for the previous calendar year. 3. The FormFire system must be used to provide notification of participating employee terminations. If the group is COBRA eligible, the continuation service provider will administrate the COBRA provisions. 4. If a group is not COBRA eligible, state continuation applies and the continuation vendor will administrate the COBRA provisions. G. Medicare coordination of benefits. 1. The Census Reconciliation provides for the calculation of the number of eligible employees required for Medicare Primary processing. 2. Participating employers eligible for Medicare Primary processing must complete registration forms before they enroll the Medicare recipient in Medicare Primary processing. 3. Medicare enrolled eligible employees must complete an employee certification to be eligible for Medicare Primary processing. H. Regulatory compliance. 1. Participating employers who offer ERISA governed benefits must comply with regulatory requirements for plan sponsors. The OFB HBP provides assistance in meeting many of these compliance requirements. 2. The FormFire enrollment platform also provides features to assist the participating employer in complying with regulatory requirements. 3. Participating employers must update FormFire or ensure their producer updates the FormFire platform in order to administrate the compliance activities. 4. Participating employers need to: i. Distribute compliance notices to employees who do not have access to web-based viewing devices. ii. Provide employees with notice that compliance documents are available. 14

15 iii. Review the appendix on compliance requirements. iv. Maintain compliance with state and federal employer requirements. I. Plan year. The plan year and the renewal year end December 31 of each year. J. Producer appointment. 1. All producers are to be approved by the OFB HBP trustees or their designee. 2. Each producer may appoint sub-producers who will be responsible to follow the producer guidelines and the contractual requirements of the producer. 3. Only approved producers and sub-producers can use the Authorized to Sell OFB HBP Products. 4. Producers are responsible for the behavior of their sub-producers. 5. Sub-producers must be approved by the OFB HBP trustees or their designee. 6. A sub-producer may be an individual or an agency with a limited number of individually identified agents in the agency. Initially, the OFB HBP will use a limit of eight sub-producers per producer. Nationwide agents will not count toward the sub-producer limit. 7. A sub-producer may be delegated some FormFire functions, but the producer is ultimately responsible for accurate case submissions. 8. The goal of producer appointment is to create an OFB HBP distribution force that is knowledgeable about OFB, MEWAs in general, the OFB HBP, and the underwriting and case submission process. 9. Referral arrangements with non-producers or non-sub-producers are possible however, it suggested that a producer should maintain no more than 10 referral arrangements in order to create product knowledge and expertise. Nationwide agents are not counted in this referral limit guideline. 15

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17 APPENDIX

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19 OFB Health Benefits Plan Participating Employer Compliance Guide R e f Compliance Requirement or Feature Time of Hire Key Participating Employer Responsibilities N o t e Comment When Who Distributes Document (1) 1 Children's Health Insurance Progam Reauthorizatio A Employee Notice - Time Of Hire At time of hire Employer 2 Health Exchange Availability A Plan provides, employer distributes At date of hire Employer Time of Enrollment 3 Summary Benefit Comparison ("SBC") B Anthem prepares, PE distributes At enrollment time Employer 4 Continuation Notice C Employer maintains OFB HBP Zone At enrollment time OFB HBP 5 Medicare Part D Creditable Coverage D Employee Notice - Enrollment At enrollment time Employer 6 HIPPA Special Enrollment Rights D Employee Notice - Enrollment At enrollment time Employer 7 Women's Health Cancer Rights Act D Employee Notice - Enrollment At enrollment time Employer 8 Children's Health Insurance Progam Reauthorizatio D Employee Notice - Enrollment At enrollment time Employer 9 Summary of HIPAA Privacy Notice D Employee Notice - Enrollment At enrollment time Employer 10 OFB HBP Plan Document E OFB HBP provides Enrollee requests Employer 11 Summary Plan Description ("SPD") Plan 501 F OFB HBP provides 90 days post enrollment Empoyer 12 Summary Plan Description ("SPD") Plan 502 F OFB HBP provides 90 days post enrollment Employer 13 Summary Annual Report ("SAR") G Plan provides, Employer distributes 9 months post plan year end Employer 14 Individual Mandate Sec 6055 Form 1094 H Employer prepares tax form See IRS Guidelines n/a 15 Medicare Primary Registration - Employer I Employers < 20 E's register When Employer < 20 E's n/a 16 Medicare Employee Registration I Employees eligible for Medicare When Employer < 20 E's Employer 17 Non-Discrimination J Employers must not discriminate Continuously n/a 18 Summary of Modification ("SMM") K Plan provides, Employer distributes 210 days post plan year end Employer 19 Summary of Material Reduction ("SMR") L Plan provides, Employer distributes Within 60 days of change Employer This Guide is being provided to you, as a Participating Employer in the Ohio Farm This Bureau Guide Health is being Benefits provided Plan to (the you, Plan ), as a Participating to help you Employer comply in with the Ohio various Farm Federal Bureau Health and state Benefits requirements Plan (the applicable Plan ), to to help employers you comply offering with health various coverage Federal and state requirements other benefits applicable to their to employees employers and offering their health family coverage members. and other benefits to their employees and their family members OFB HBP Compliance Guide v.1 - Copyright 2016 Consoliplex 19

20 Other Compliance Requirements and Responsibilities Compliance Requirement or Feature N o t e Comment When Who Distributes Document (1) 0 Employer Mandate Sec Form 1095 H Plan does not target employers >50 e. Employer Files Return n/a 1 Notice of Benefit Determination M Anthem provides in EOB EOB is delivered to enrollee Anthem 2 Internal Claims Appeal Process N OFB HBP provides in SPD Enrollee appeals Employer 3 External Claim Review Process N OFB HBP provides in SPD Enrollee appeals Employer 4 Qualified Medical Support Order N OFB HBP Provides in SPD SPD is provided Employer 5 Childrens Health Insurance Program (CHIPR") N OFB HBP Provides in SPD SPD is provided Employer 6 Newborn Mother's Health Protection ("NMHPA") N OFB HBP Provides in SPD SPD is provided Employer 7 Michelle's Law - College Students N OFB HBP Provides in SPD SPD is provided Employer 8 Womens Health Cancer Rights Act ("WHCRA") N OFB HBP Provides in SPD SPD is provided Employer 9 Mental Health Parity Addiciton Equality ("MHPAEA N OFB HBP Provides in SPD SPD is provided Employer 0 Genetic Informaiton and Nondiscrimination N OFB HBP Provides in SPD SPD is provided Employer 0 Notice of Granfathered Status - Plans are not grandfathered n/a n/a 1 Form M-1 O OFB HBP files March 31st and special times n/a 2 Form 5500 P OFB HBP prepares and files Form 5500 is filed n/a 3 Notice of Pre-Exisiting Coverage Notice - Not needed, guaranteed issue n/a n/a 4 Benefit Book - Medical Plans B Included as a SPC section SPD is provided Employer 5 Summary HIPPA Privacy Notice D Employee Notice - Enrollment At enrollment time Employer 6 HIPPA and State Privacy Practices P Employee Notice - Enrollment Employee request Employer 7 HIPPA Privacy and Security Policy Q OFB HBP Provides on Request Employee request Employer 8 Privacy and Security Officer Q OFB HBP provides Notice and SPD SPD and Notice provided Employer 9 Business Associate Agreeement Q OFB HBP provides to associates When contract signed n/a 1 Notice of Minimum Essential Coverage B All Plans are minimum essential SBC is provided Employer 2 Minimum Value Determination B All Plans are minimum vlaue SBC is provided Employer 3 Aggregate Cost of Employer Sponsored Benefit Q Not required for Employers <200 PE prepares W-2 n/a 4 PCORI Fee - OFB HBP pays OFB HBP files return n/a 5 State Premium Tax - NA for self-funded plans. Not applicable n/a 6 Transitional reinsurance fee - OFB HBP pays OFB HBP notifies CMS n/a 7 Preparation of Form OFB HBP files OFB HBP files with IRS n/a 8 NAIC Annual and Quarterly Statements - OFB HBP files Per ODI requirements n/a Initially you should note the compliance documents are located in the OFB HBP Zone nitially you should note the compliance documents are located in the OFB HBP Zone website maintained by FormFire. Your insurance agent will help you access this website. ebsite maintained by FormFire. Your insurance agent will help you access this website. ormfire FormFire has has been been engaged engaged as as the the enrollment enrollment manager manager for for the the OFB OFB HBP HBP Zone. Zone. You must go to the OFB HBP Zone to access the various documents that you need to OFB HBP Compliance Guide v.1 - Copyright 2016 Consoliplex provide to employees participating in the various benefits. The OFB HBP Zone also provides the employees with access to many features including various notices and appropriate alerts. Important: You must maintain the OFB HBP Zone to ensure the Plan has accurate enrollment data which will help you with your compliance activities. 20

21 The Participating Employer Compliance Guide-Key Participating Employer Responsibilities at the beginning of this document is designed to assist you, the Participating Employer, in identifying key compliance responsibilities. Most of the responsibilities involve various employee notice requirements and that have to be provided whenever an employer offers health coverage and other employee benefits. Employers should review and understand their compliance responsibilities when employees are hired, at annual enrollment or at special enrollment times as well as when qualifying events occur, and when employees terminate employment. The section entitled Other Compliance Requirements and Responsibility outlines other requirements that are applicable to employers that sponsor employee benefit plans. These requirements are either handled by other entities or require you to perform certain functions. Both sections provide an overview of how the SOCA Benefit Plan assists you in meeting your compliance responsibilities. The requirements are subject to change at any time. This guides in not an exhaustive listing of all employer compliance responsibilities. Many employers want to distribute the notices electronically. There are rules governing the electronic distribution of certain notices. Employers can distribute various notices and documents to an employee electronically only if the employee has work related computer access. In other words, the employee has to use the computer as part of his or her job duties. If the employee s job duties do not require computer access the documents should be distributed in paper format rather than in electronic format. The rules governing the electronic distributions of ERISA documents are located at this address: It is important to comply with the various rules. Those rules apply whenever an employer offers employees various benefits. The fact the Plan is a multiple employer welfare arrangements or MEWA providing self funded medical benefits does not alter or change those compliance rules. Participating Employers are encouraged to contact legal counsel to ensure they are aware of all of their employer responsibilities. Notes in the Participating Employer Compliance Guide A. Employee Notice Time of Hire. We have placed the Children s Health Insurance Program Reauthorization in the new hire notice. Ohio doesn t participate in the program, but we indicate there is a notice obligation if any of your employees reside in another state that does participate in the Children s Health Insurance Program Reauthorization. In that case, you should distribute the notice to those employees. The availability of the health exchange notice is also included. 21

22 22 Children s Health Insurance Program Reauthorization Act or CHIPRA. Some states have instituted programs under which low income individual can receive financial assistance to help pay health plan premiums for children. Although Ohio has not adopted this type of program, the notice requirements are met in the event there is an out of state resident in a state that does provide benefits. Health Care Exchange Notices. One of the main components of health care reform was the establishment of health care exchanges where individuals can go to buy health coverage. The law requires that employers provide all new employees a government notice explaining the availability of health care exchanges. This notice has to be provided to all employees, whether or not they enroll in the Plan, within 14 days after the employee is first hired. B. Summary of Benefits and Coverage or SBC. The Summary of Benefits and Coverage or SBC is a uniform four-page summary of the Plan. The Plan offers a number of different options when it comes to medical benefits. Once you have selected the medical benefits you want to offer to your employees, you have to distribute the SBC listing those options to the employees. The OFB HBP Zone contains a copy of the SBC in the document library. The SBC should be distributed during the annual open enrollment period and when the employee is first eligible to participate in the Plan. C. Continuation of Coverage. The Plan has arranged for a service provider to comply with benefit continuation requirements. It is important to understand you, as the Participating Employer, need to update enrollment information in the OFB HBP Zone in order ensure compliance with continuation responsibilities. COBRA. A Federal statute, called COBRA, applies to employers with 20 or more employees. Employers that are subject to COBRA must offer certain individuals, called qualified beneficiaries, the opportunity to continue their Plan coverage when certain events, called qualifying events, happen. Ohio Law. Ohio has a law that requires employers with less than 20 employees to allow former employees and their family members to continue participating in the Plan under certain circumstances occur when the employee is terminated. There are various notice requirements under both COBRA and the Ohio rules. It is imperative that you notify the Plan whenever someone begins or loses coverage under the Plan. You must notify the Plan, within ten (10) days when someone enters or leaves the Plan by using OFB HBP Zone to update the change in enrollment status. If you fail to notify the Plan in a timely manner, you could be subject to substantial penalties. You must update the employee enrollment in the OFB HBP Cloud weekly in order for the continuation service provider to help you satisfy these compliance requirements.

23 D. OFB HBP Employee Notice Enrollment. The Plan has prepared a list of notices that should be provided at the various enrollment times - initial enrollment, annual open enrollment, special enrollment, and other qualifying events. The OFB HBP Employee Notice-Enrollment document will be in the OFB HBP Zone document library. The portion of Employee Notice-Enrollment is populated with your specific data. Federal law requires employers to provide certain other notices and disclosures to the employees at different times during the year. The Plan will, from time to time, notify you of notices and disclosures distribution requirements. Employees with internet access will have access to the Enrolled Employee Document Library and can read their notices online. The following is a summary of some of these notices and disclosures contained in the Enrolled Employee Document Library. Medicare Part D Creditable Coverage Notice. Medicare has a voluntary prescription drug benefit for those enrolled in Medicare. Employers are required to distribute a Medicare Part D Creditable Coverage prior to when an employee enrolls in the Plan and annually thereafter. HIPAA Special Enrollment Rights. Federal law provides that some individuals may enter the Plan mid-year if certain events happen. The law requires that you notify all employees about these special enrollment rights when they are first eligible to participate in the Plan. Women s Health Cancer Rights Act or WHCRA. Health plans have to provide mastectomy related reconstructive surgery, prostheses and treatment of physical complications of mastectomy. The SPD Benefit Book contains benefits allowing the required services. Children s Health Insurance Program Reauthorization Act or CHIPRA. Some states have instituted programs under which low income individual can receive financial assistance to help pay health plan premiums for children. Although Ohio has not adopted this type of program, the notice requirements are met in the event there is an out of state resident in a state that does provide benefits. Summary of HIPAA Privacy Notice. Federal law requires the Plan to protect the people s personal protected health information or PHI. This notice has to be given to the employee that are covered under the Plan at the time they enroll in the Plan. Employers will not have access to PHI so any employee questions regarding PHI should be directed to the Plan Administrator. 23

24 E. Plan Document. OFB HBP prepares the Plan Document for the self funded medical benefit plan. The Plan Document should be signed by you. It is available in the OFB HBP Zone document library. The Plan Document does not have to be distributed to the employees but it should be made available to employees to review on an as requested basis. F. Summary Plan Description ( SPD ). The SPD lists key facts about the Plan including the Plan s eligibility requirements and a detailed description of Plan benefits. The SPD with the Schedule of Benefits and Benefit Book for the medical and prescription drug plans should be provided to the employees who enroll in the Plan. Parts of the SPD is populated with your specific data and is available in the OFB HBP Zone. The SPD for the medical benefits along with a health reimbursement account (if applicable) will be assigned Plan Number 501. The ancillary products available in the OFB HBP Zone will be assigned Plan Number 502. If you are offering your employees benefits outside the OFB HBP Zone you should contact your legal counsel to prepare the summary plan description for those other employee benefits. To help you comply with this requirement, the OFB HBP recommends you contact: Paul Routh, Esq. Dunlevey, Mahan & Furry, Attorneys at Law 3931 South Dixie Drive Dayton, Ohio Telephone pjr@dmfdayton.com Dunlevey, Mahan & Furry have extensive experience in preparing SPDs and the coordination of the SPD in the Plan. G. Summary Annual Report ( SAR ) The summary annual report or SAR summaries the Plan s activities each year. The Plan will provide you the SAR which you should distribute to the employees participating in the Plan. The SAR will be available in the OFB HBP Zone document library. H. Health Care Reform Reporting- IRS Form 1094-B and IRS Form 1095-B. These requirements are similar to the requirements for IRS Form W-3 and IRS Form W-2 filing. Health care reform imposes new reporting requirements on employers sponsoring self funded health plans. Small employers (i.e. those with less than 50 full time and full time equivalent employees) that sponsor self funded health plans must complete and submit IRS Form 1094-B and IRS Form 1095-B. The employer provides a copy of IRS Form 1095-B to all their employees. Employers with over 50 employees may be subject to the employer mandate, but such employers are not eligible to participate in the Plan. 24

25 I. Medicare Primary Registration. The Medicare Secondary Payer Rules require certain employer sponsored group health plans coordinate benefits with Medicare if the person is covered under both the employer s group health plan and Medicare. Therefore, it is important that you provide certain information so that the OFB HBP can comply with these Medicare Secondary Payer Rules. You must maintain the OFB HBP Zone census reconciliation which includes the identification of the number of employees you have subject to the Medicare Primary Registration requirements. The rule states you must have had no more than 20 employees, full or part-time or leased, on each working day in least 20 weeks in the current or preceding year. We use December 31st as the measurement date for the Plan. When you input the number of employees, the OFB HBP Zone will notify appropriate Plan service providers. Plan representatives will contact you with instructions on completing the correct registration forms. If you have less than 20 qualified employees with at least one Medicare enrollee and you do not complete the forms, your premium may higher. J. Non-Discrimination. The federal government precludes employer sponsoring self funded health plans from discriminating in favor of highly compensated employees. The Plan does not perform discrimination testing. However, if the same benefits are offered to all eligible employees and the contributions are the same for everyone in the same tier (e.g. single coverage or family coverage), then it is very likely the Plan is not discriminatory. For example, if the Plan is available to all full time employees, all employees have the same waiting period and everyone electing single coverage pay the same amount and everyone electing family coverage pay the same amount, the Plan should pass the discrimination testing rules. The Plan requires the following: 1. No segmenting of Eligible Employees into different groups with different benefits or contribution requirements. 2. Use a flat dollar contribution rate that is coordinated with only the contract type, e.g. single or family contribution rates. Please see legal counsel for further guidance on managing non-discrimination. K. Summary of Material Modification ( SMM ) Federal law requires the distribution of this notice within 210 days after the close of the plan year during which the change in benefits happened. The Plan will either update the Medical SPD or will provide this notice in the OFB HBP Zone. Therefore, there is no need to provide a Summary of Material Modification or SMM if the Medical SPD is updated each Plan year. L. Summary of Material Reduction ( SMR ). Federal law requires the distribution of this notice when there is material reduction in benefits within 60 days of the change. The Plan intends on either updating the Medical SPD or providing this notice in the OFB HBP Zone. Therefore, there is no need to provide a Summary of Material Reduction or SMR if the Medical SPD is updated each Plan ear. 25

26 M. Notice of Benefit Determination. Medical Mutual Services will provide a notice of benefit determination and the participants right to appeal on the explanation of benefits. N. Notices and Disclosures. The SPD Benefit Book Section contains many required notices, disclosures and benefit definitions. If the Benefit Book and SPD are distributed to the employees you will be in compliance with these notice requirements. O. Form M-1. All multiple employer welfare arrangements or MEWAs have to file a Form M-1 with the Federal government each year. The Plan will file this form. Therefor you will not have to do anything with respect to the Form M-1 filing. P. Form 5500SF. The Plan files the appropriate Form 5500SF for the Plan and each Participating Employer so you will not have to file this form. The form is filed electronically. The OFB HBP Zone will contain a copy of this form in the document library. Q. HIPPA Policies and Procedures. You are not entitled to access Protected Health Information. The Plan has HIPPA Policies and Procedures that you or Enrolled Employees may access. Please request the Plan Administrator for this information. The Plan obtains Business Associate Agreements from entities that may receive PHI. The following is important contact information. Plan Administrator Ohio Farm Bureau Health Benefits Plan Attn: Plan Administrator 280 North High Street Floor 6 Columbus, Ohio Telephone

27 SIC CODE SIC Description 116 Soybeans 119 Cash Grains, Nec 119 Cash Grains, Nec 111 wheat 115 Corn 112 Rice 119 Cash Grains, Nec 139 Field Crops, Except Cash Grain 134 Irish Potatoes 139 Field Crops, Except Cash Grain 161 Vegetables and Melons 174 Citrus Fruits 174 Citrus Fruits 175 Deciduous Tree Fruits 172 Grapes 171 Berry Crops 171 Berry Crops 173 Tree Nuts 179 Fruits and Tree Nuts, Nec 175 Deciduous Tree Fruits 182 Food Crops Grown Under Cover 182 Food Crops Grown Under Cover 181 Ornamental Nursery Products 181 Ornamental Nursery Products 132 Tobacco 131 Cotton 133 Sugarcane and Sugar Beets 139 Field Crops, Except Cash Grain 133 Sugarcane and Sugar Beets 139 Field Crops, Except Cash Grain 139 Field Crops, Except Cash Grain 2099 Food Preparations, Nec 831 Forest Products 191 General Farms, Primarily Crop 241 Dairy Farms 211 Beef Cattle Feedlots 241 Dairy Farms 213 Hogs 252 Chicken Eggs 251 Broiler, Fryer, and Roaster Chickens 253 Turkeys and Turkey Eggs 254 Poultry Hatcheries 259 Poultry and Eggs, Nec 214 Sheep and Goats 219 General Livestock, Nec 921 Fish Hatcheries and Preserves 273 Animal Aquaculture OFB HBP QUALIFYING SIC/ NAICS INDUSTRY CODES NAICS CODE NAICS Description Soybean Farming Oilseed (except Soybean) Farming Dry Pea and Bean Farming Wheat Farming Corn Farming Rice Farming Oilseed and Grain Combination Farming All Other Grain Farming Potato Farming Other Vegetable (except Potato) and Melon Farming Other Vegetable (except Potato) and Melon Farming Orange Groves Citrus (except Orange) Groves Apple Orchards Grape Vineyards Strawberry Farming Berry (except Strawberry) Farming Tree Nut Farming Fruit and Tree Nut Combination Farming Other Noncitrus Fruit Farming Mushroom Production Other Food Crops Grown Under Cover Nursery and Tree Production Floriculture Production Tobacco Farming Cotton Farming Sugarcane Farming Hay Farming Sugar Beet Farming eanut Farming All Other Miscellaneous Crop Farming All Other Miscellaneous Crop Farming All Other Miscellaneous Crop Farming All Other Miscellaneous Crop Farming Beef Cattle Ranching and Farming Cattle Feedlots Dairy Cattle and Milk Production Hog and Pig Farming Chicken Egg Production Broilers and Other Meat Type Chicken Production Turkey Production Poultry Hatcheries Other Poultry Production Sheep Farming Goat Farming Finfish Farming and Fish Hatcheries Shellfish Farming 27

28 SIC CODE SIC Description 273 Animal Aquaculture 279 Animal Specialties, Nec 272 Horses and Other Equines 271 Fur-bearing Animals and Rabbits 291 General Farms, Primarily animals 811 Timber Tracts 2411 Logging 912 Finfish 913 Shellfish 919 Miscellaneous Marine Products 971 Hunting, Trapping, Game Propagation 724 Cotton Ginning 721 Crop Planting and Protection 711 Soil Preparation Services 722 Crop Harvesting 723 Crop Preparation Services For Market 761 Farm Labor Contractors 762 Farm Management Services 751 Livestock Services, Except Veterinary 851 Forestry Services 1422 Agricultural limestone, ground 1479 Chemical and Fertilizer Mining 1781 Water Well Drilling 2047 Dog and Cat Food 723 Crop Preparation Services For Market 2048 Prepared Feeds, Nec 2034 Dehydrated Fruits, Vegetables, Soups 2041 Flour and Other Grain Mill Products 2044 Rice Milling 2083 Malt 2046 Wet Corn Milling 2074 Cottonseed Oil Mills 2079 Edible Fats and Oils 2075 Soybean Oil Mills 2076 Vegetable Oil Mills, Nec 2046 Wet Corn Milling 2043 Cereal Breakfast Foods 2063 Beet Sugar 2062 Cane Sugar Refining 2061 Raw Cane Sugar 2067 Chewing Gum 2066 Chocolate and Cocoa Products 2064 Candy and Other Confectionery Products 5441 Candy, Nut, and Confectionery Stores 2037 Frozen Fruits and Vegetables 2038 Frozen Specialties, Nec 2033 Canned Fruits and Specialties 2035 Pickles, Sauces, and Salad Dressings 2032 Canned Specialties 2034 Dehydrated Fruits, Vegetables, Soups NAICS CODE NAICS Description Other Aquaculture Apiculture Horses and Other Equine Production Fur-Bearing Animal and Rabbit Production All Other Animal Production Timber Tract Operations Logging Finfish Fishing Shellfish Fishing Other Marine Fishing Hunting and Trapping Cotton Ginning Soil Preparation, Planting, and Cultivating Soil Preparation, Planting, and Cultivating Crop Harvesting, Primarily by Machine Postharvest Crop Activities (except Cotton Ginning) Farm Labor Contractors and Crew Leaders Farm Management Services Support Activities for Animal Production Support Activities for Forestry Crushed and Broken Limestone Mining and Quarrying Other Chemical and Fertilizer Mineral Mining Water and Sewer Line and Related Structures Construction Dog and Cat Food Manufacturing Other Animal Food Manufacturing Other Animal Food Manufacturing Flour Milling Flour Milling Rice Milling Malt Manufacturing Wet Corn Milling Soybean and Other Oilseed Processing Soybean and Other Oilseed Processing Soybean and Other Oilseed Processing Fats and Oils Refining and Blending Fats and Oils Refining and Blending Breakfast Cereal Manufacturing Beet Sugar Manufacturing Cane Sugar Manufacturing Cane Sugar Manufacturing Nonchocolate Confectionery Manufacturing Chocolate and Confectionery Manufacturing from Cacao Beans Confectionery Manufacturing from Purchased Chocolate Confectionery Manufacturing from Purchased Chocolate Frozen Fruit, Juice, and Vegetable Manufacturing Frozen Specialty Food Manufacturing Fruit and Vegetable Canning Fruit and Vegetable Canning Specialty Canning Dried and Dehydrated Food Manufacturing 28

29 SIC CODE SIC Description 2023 Dry, Condensed, Evaporated Products 2021 Creamery Butter 2022 Cheese; Natural and Processed 2026 Fluid Milk 2024 Ice Cream and Frozen Desserts 2011 Meat Packing Plants 5147 Meats and Meat Products 2077 Animal and Marine Fats and Oils 2091 Canned and Cured Fish and Seafoods 2092 Fresh or Frozen Packaged Fish 5461 Retail Bakeries 2051 Bread, Cake, and Related Products 2053 Frozen Bakery Products, Except Bread 2052 Cookies and Crackers 2098 Macaroni and Spaghetti 2045 Prepared Flour Mixes and Doughs 2068 Salted and Roasted Nuts and Seeds 2052 Cookies and Crackers 2096 Potato Chips and Similar Snacks 2095 Roasted Coffee 2087 Flavoring Extracts and Syrups, Nec 2035 Pickles, Sauces, and Salad Dressings 2899 Chemical Preparations, Nec 2082 Malt Beverages 2086 Bottled and Canned Soft Drinks 2085 Distilled and Blended Liquors 2131 Chewing and Smoking Tobacco 2111 Cigarettes 2121 Cigars 2141 Tobacco Stemming and Redrying 2282 Throwing and Winding Mills 2281 Yarn Spinning Mills 2211 Broadwoven Fabric Mills, Cotton 2231 Broadwoven Fabric Mills, Wool 2297 Nonwoven Fabrics 2262 Finishing Plants, Manmade 2298 Cordage and Twine 2386 Leather and Sheep-lined Clothing 3151 Leather Gloves and Mittens 2371 Fur Goods 2399 Fabricated Textile Products, Nec 3111 Leather Tanning and Finishing 3199 Leather Goods, Nec 2421 Sawmills and Planing Mills, General 2491 Wood Preserving 2499 Wood Products, Nec 2429 Special Product Sawmills, Nec 2448 Wood Pallets and Skids 2452 Prefabricated Wood Buildings 2449 Wood Containers, Nec NAICS CODE NAICS Description Fluid Milk Manufacturing Creamery Butter Manufacturing Cheese Manufacturing Dry, Condensed, and Evaporated Dairy Product Manufacturing Ice Cream and Frozen Dessert Manufacturing Animal (except Poultry) Slaughtering Meat Processed from Carcasses Rendering and Meat Byproduct Processing Seafood Product Preparation and Packaging Seafood Product Preparation and Packaging Retail Bakeries Commercial Bakeries Frozen Cakes, Pies, and Other Pastries Manufacturing Cookie and Cracker Manufacturing Dry Pasta, Dough, Flour Mixes Manufacturing from Purchased Flour Dry Pasta, Dough, Flour Mixes Manufacturing from Purchased Flour Roasted Nuts and Peanut Butter Manufacturing Other Snack Food Manufacturing Other Snack Food Manufacturing Coffee and Tea Manufacturing Flavoring Syrup and Concentrate Manufacturing Mayonnaise, Dressing, and Other Prepared Sauce Manufacturing Spice and Extract Manufacturing Spice and Extract Manufacturing Soft Drink Manufacturing Wineries Tobacco Manufacturing Tobacco Manufacturing Tobacco Manufacturing Tobacco Manufacturing Fiber, Yarn, and Thread Mills Fiber, Yarn, and Thread Mills Broadwoven Fabric Mills Broadwoven Fabric Mills Nonwoven Fabric Mills Textile and Fabric Finishing Mills Rope, Cordage, Twine, Tire Cord, and Tire Fabric Mills All Other Miscellaneous Textile Product Mills All Other Miscellaneous Textile Product Mills Other Cut and Sew Apparel Manufacturing Apparel Accessories and Other Apparel Manufacturing Leather and Hide Tanning and Finishing All Other Leather Good and Allied Product Manufacturing Sawmills Wood Preservation Cut Stock, Resawing Lumber, and Planing Other Millwork (including Flooring) Wood Container and Pallet Manufacturing Prefabricated Wood Building Manufacturing All Other Miscellaneous Wood Product Manufacturing 29