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 8 QUOTING PROCESS AND CASE SUBMISSION 11 BENEFIT PLAN OFFERINGS 13 GENERAL ADMINISTRATION 15 APPENDIX 19 A. OFB HBP BENEFIT HIGHLIGHT GRID B. OFB HBP QUALIFYING SIC/NAICS INDUSTRY CODE C. OFB HBP PARTICIPATING EMPLOYER GUIDE

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 and federal 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. Individual sole proprietors without employees are not eligible to participate. 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; and 2. Competitive rates; and 3. Predictable, fixed monthly payments; and 4. The protection of being a part of a larger self-funded pool of participants under the governance of plan trustees; and 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, see Exhibit B. An employer may operate under several NAICS detail codes. An employer can apply for special consideration by submitting documentation they service the agricultural economic sector along with their application. The OFB HBP will consider such requests on a case-by-case basis. 4

5 3. Employer status. An employer-employee relationship exists. Sole proprietors actively at work with at least one non-immediate family member employee who is non-resident in the proprietor s household are considered employers in the OFB HBP. 4. Permanent operation. The employer s operations must be permanent in nature. 5. Employee requirements. 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) may 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 the first billing after either 0, 30, 60, or 90 days of employment before eligibility begins. 3. Paid on W-2s or owners/partners. Eligible employees are those paid on W-2s or be full-time owners/partners Employees. Some entities pay their workers using 1099s. Some call these workers employees although they are not true employees. The practice can lead to many difficulties for the entity paying the worked and is discouraged. Employees should be paid through the W-2 process. However, if an individual receives their compensation via a 1099, their service is primarily to the business entity paying them and they are treated in a fashion consistent with other employees, then they are considered as an Eligible Employee for purposes of health insurance. 5

6 5. Social Security number. Eligible employees must possess a valid Social Security number. 6. 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 Employees must be transmitted on Form 1096 to the federal government. Entities should be aware they may be subject to withholding requirements. Please see your tax accountant or attorney. 7. Actively at work. Eligible employees must be actively at work. Short-term disabilities greater than 90 days result in a lack of eligibility requirement. 8. Ohio Farm Bureau members. Eligible employees must be OFB members. The employer promises to pay OFB dues with Plan Premium Equivalent Rate funding invoices. 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. Employers with over 50 full-time equivalent employees as determined under the Affordable Care Act are subject to special eligibility rules for seasonal employees. 5. Absentee employees. Employees absent from work and off payroll due to non-medical reasons. 6

7 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 and any employees. iv. Contractor works exclusively (over 90% of 1099 compenstaion) for entity. v. Report 1099 employees on Form 1096 and comply with withholding requirements. 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. 7

8 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 2 employees if there are 2 or more employees otherwise eligible. This means employers with 2 eligible employees must have both employees enrolling in order to meet the 75% net eligibility rule. A two eligible employee group with one employee waiving will be considered as meeting the 75% net eligibility rule. A three eligible employee group must have two employees waiving. Four or more employees must meet a strict 75% net of waiver eligibility rule. 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. Such members are not considered as eligible employees in the denominator of the 75% net eligibility rule. 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. 8

9 4. OFB HBP requires the employer may fund up to 60% of the benefit plan deductible if a HRA is used. Employer contributions to an employee HSA do not count towards this limit. For example, an employee must fund up to 40% of the plan deductible. An employee s HSA may be used to satisfy the 40% requirement regardless of the source of the HSA funding. 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 consisting of the first OFB HBP billing date of 0, 30, 60, or 90 days of employment are established by the employer. 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. 4. Employees must complete health statements for dependents. 5. Information needs to be complete, so additional questions may be required. 9

10 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 or the effective date if the employer is enrolling other then January 1st. The plan s annual renewal date is January 1st. 3. 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 OFB HBP Trustee approved producers or sub-producers may represent themselves as Authorized to sell OFB HBP Products. b. Only appointed producers may distribute the OFB HBP. c. All producers must be approved by OFB HBP trustees or their designee. d. Sub-producers must be approved by the OFB HBP trustees or their designee. Producers must submit a written request to approve a subproducer to the plan administrator. e. 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. f. Producers are appointed with the understanding they may enter manually completed applications as long as they attach copies of the applications in the Form Fire system. g. Producers ore sub-producers may use referral sources as long as the producer or sub-producer is responsible for sales and service of the participating employer. 10

11 QUOTING 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. The use of FormFire by either the participating employer or the producer is required in order to maintain OFB HBP plan eligibility and to ensure appropriate administration of the OFB HBP. 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. Producers may use a quick quote to ascertain if the OFB HBP is suitable for a potential participating employer. 2. Underwritten rate. The following items are required to prepare an underwritten rate. i. FormFire formatted census. ii. Employee health statements. 11

12 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 (in a format accepted 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. Note: if submitting at least 30 days before the effective date and using EFT, no binder check is required. 12

13 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 benefit options will be responsible for the preparation of their own summary plan descriptions for ancillary benefits. 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. 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. 13

14 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. 14

15 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 assessed for reinstatement. Reinstatements after the 5 business day period will be subject to underwriting. 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. 15

16 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. 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. 16

17 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. iii. Review the appendix on compliance requirements. iv. Maintain compliance with state and federal employer requirements. See Exhibit A for a guide to compliance activities. 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 8 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 the OFBF, 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, we suggest 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. 17

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19 APPENDIX

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21 Exhibit A Ohio Farm Bureau Health Benefits Plan Health Benefit Design Overview: There are two plan types available to businesses in the OFB HBP. Groups of 5 or more can offer two plan choices from the eight available benefit designs and groups of 10 or more can offer three choices. High Deductible Health Plans ( HDHP ): Deductible Deductible Single Out of Family Out of Physician Rx Plan Name: Single: Family: Pocket Max: Pocket Max: Copays: Copays: HDHP $3,000 $3,000 $6,000 $3,000 $6,000 None None HDHP $4,000 $4,000 $8,000 $4,000 $8,000 None None HDHP $5,000 $5,000 $10,000 $5,000 $10,000 None None HDHP $6,350 $6,350 $12,700 $6,350 $12,700 None None 80% Coinsurance Plans: Deductible Deductible Single Out of Family Out of Physician Rx Plan Name: Single: Family: Pocket Max: Pocket Max: Copays: Copays: $500-80% $500 $1,000 $1,500 $3,000 $25/$50 $15/30/60 $1,000-80% $1,000 $2,000 $2,500 $5,000 $25/$50 $15/30/60 $2,250-80% $2,250 $4,500 $4,500 $9,000 $25/$50 $15/30/60 $5,000-80% $5,000 $6,600 $10,000 $13,200 $25/$50 $15/30/60 *This is an illustrative guide to the benefits available under the Ohio Farm Bureau Health Benefits Plan. Consult the Summary of Benefits and Coverage and the Benefit Book for each plan to get more information about the services covered and the costs to a covered person. 21

22 Exhibit B OFB HBP QUALIFYING SIC/ NAICS INDUSTRY CODES 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 22 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

23 SIC CODE SIC Description 219 General Livestock, Nec 921 Fish Hatcheries and Preserves 273 Animal Aquaculture 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 NAICS CODE NAICS Description Goat Farming Finfish Farming and Fish Hatcheries Shellfish Farming 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 23

24 SIC CODE SIC Description 2035 Pickles, Sauces, and Salad Dressings 2032 Canned Specialties 2034 Dehydrated Fruits, Vegetables, Soups 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 NAICS CODE NAICS Description Fruit and Vegetable Canning Specialty Canning Dried and Dehydrated Food Manufacturing 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) 24

25 SIC CODE SIC Description 2448 Wood Pallets and Skids 2452 Prefabricated Wood Buildings 2449 Wood Containers, Nec 2869 Industrial Organic Chemicals, Nec 2869 Industrial Organic Chemicals, Nec 2865 Cyclic Crudes and Intermediates 2861 Gum and Wood Chemicals 2823 Cellulosic Manmade Fibers 2824 Organic Fibers, Noncellulosic 2873 Nitrogenous Fertilizers 2874 Phosphatic Fertilizers 2875 Fertilizers, Mixing Only 2879 Agricultural Chemicals, Nec 2833 Medicinals and Botanicals 3274 Lime 3275 Gypsum Products 3423 Hand and Edge Tools, Nec 3425 Saw Blades and Handsaws 3411 Metal Cans 3523 Farm Machinery and Equipment 3524 Lawn and Garden Equipment 3556 Food Products Machinery 3552 Textile Machinery 5031 Lumber, Plywood, and Millwork 5083 Farm and Garden Machinery 5141 Groceries, General Line 5142 Packaged Frozen Goods 5143 Dairy Products, Except Dried or Canned 5144 Poultry and Poultry Products 5145 Confectionery 5146 Fish and Seafoods 5147 Meats and Meat Products 5148 Fresh Fruits and Vegetables 5149 Groceries and Related Products, Nec 5153 Grain and Field Beans 5154 Livestock 5159 Farm-product Raw Materials, Nec 5181 Beer and Ale 5182 Wine and Distilled Beverages 5191 Farm Supplies 5193 Flowers and Florists Supplies 5194 Tobacco and Tobacco Products 5261 Retail Nurseries and Garden Stores 5141 Groceries, General Line 5411 Grocery Stores 5421 Meat and Fish Markets 5147 Meats and Meat Products 5146 Fish and Seafoods 5148 Fresh Fruits and Vegetables 5431 Fruit and Vegetable Markets NAICS CODE NAICS Description Wood Container and Pallet Manufacturing Prefabricated Wood Building Manufacturing All Other Miscellaneous Wood Product Manufacturing Other Basic Inorganic Chemical Manufacturing Ethyl Alcohol Manufacturing Cyclic Crude, Intermediate, Gum and Wood Chemical Manufacturing Cyclic Crude, Intermediate, Gum and Wood Chemical Manufacturing Artificial and Synthetic Fibers and Filaments Manufacturing Artificial and Synthetic Fibers and Filaments Manufacturing Nitrogenous Fertilizer Manufacturing Phosphatic Fertilizer Manufacturing Fertilizer (Mixing Only) Manufacturing Pesticide and Other Agricultural Chemical Manufacturing Medicinal and Botanical Manufacturing Lime Manufacturing Gypsum Product Manufacturing Saw Blade and Handtool Manufacturing Saw Blade and Handtool Manufacturing Metal Can Manufacturing Farm Machinery and Equipment Manufacturing LawnGarden TractorHome Lawn Garden Equipment Manufacturing Food Product Machinery Manufacturing Other Industrial Machinery Manufacturing Lumber, Plywood, Millwork, and Wood Panel Merchant Wholesalers Farm and Garden Machinery and Equipment Merchant Wholesalers General Line Grocery Merchant Wholesalers Packaged Frozen Food Merchant Wholesalers Dairy Product (except Dried or Canned) Merchant Wholesalers Poultry and Poultry Product Merchant Wholesalers Confectionery Merchant Wholesalers Fish and Seafood Merchant Wholesalers Meat and Meat Product Merchant Wholesalers Fresh Fruit and Vegetable Merchant Wholesalers Other Grocery and Related Products Merchant Wholesalers Grain and Field Bean Merchant Wholesalers Livestock Merchant Wholesalers Other Farm Product Raw Material Merchant Wholesalers Beer and Ale Merchant Wholesalers Wine and Distilled Alcoholic Beverage Merchant Wholesalers Farm Supplies Merchant Wholesalers Flower, Nursery Stock, Florists Supplies Merchant Wholesalers Tobacco and Tobacco Product Merchant Wholesalers Nursery, Garden Center, and Farm Supply Stores Supermarkets and Other Grocery (except Convenience) Stores Supermarkets and Other Grocery (except Convenience) Stores Meat Markets Meat Markets Fish and Seafood Markets Fruit and Vegetable Markets Fruit and Vegetable Markets 25

26 SIC CODE SIC Description 5461 Retail Bakeries 5451 Dairy Products Stores 5181 Beer and Ale 5921 Liquor Stores 5499 Miscellaneous Food Stores 5948 Luggage and Leather Goods Stores 5992 Florists 5194 Tobacco and Tobacco Products 5993 Tobacco Stores and Stands 6159 Miscellaneous Business Credit 6211 Security Brokers and Dealers 6211 Security Brokers and Dealers 6221 Commodity Contracts Brokers, Dealers 6221 Commodity Contracts Brokers, Dealers 6231 Security and Commodity Exchanges 6289 Security and Commodity Service 6331 Fire, Marine, and Casualty Insurance 6411 Insurance Agents, Brokers, and Service 781 Landscape Counseling and Planning 781 Landscape Counseling and Planning 741 Veterinary Services For Livestock 742 Veterinary Services, Specialties 782 Lawn and Garden Services 783 Ornamental Shrub and Tree Services 7948 Racing, Including Track Operation 8422 Botanical and Zoological Gardens 8422 Botanical and Zoological Gardens 5812 Eating Places 5812 Eating Places 5812 Eating Places 5812 Eating Places 5812 Eating Places 752 Animal Specialty Services 8611 Business Associations 9512 Land, Mineral, and Wildlife Conservation NAICS CODE NAICS Description Baked Goods Stores All Other Specialty Food Stores Beer, Wine, and Liquor Stores Beer, Wine, and Liquor Stores Food (Health) Supplement Stores Luggage and Leather Goods Stores Florists Tobacco Stores Tobacco Stores Sales Financing Investment Banking and Securities Dealing Securities Brokerage Commodity Contracts Dealing Commodity Contracts Brokerage Securities and Commodity Exchanges Trust, Fiduciary, and Custody Activities Direct Property and Casualty Insurance Carriers Insurance Agencies and Brokerages Landscape Architectural Services Other Scientific and Technical Consulting Services Veterinary Services Veterinary Services Landscaping Services Landscaping Services Racetracks Zoos and Botanical Gardens Nature Parks and Other Similar Institutions Food Service Contractors Caterers Full-Service Restaurants Limited-Service Restaurants Cafeterias, Grill Buffets, and Buffets Pet Care (except Veterinary) Services Business Associations Administration of Conservation Programs 26

27 Exhibit C OFB Health Benefits Plan Participating Employer Compliance Guide This Guide is is being provided to you, to you, as a as Participating a Participating Employer Employer in the Ohio in the Farm Ohio Bureau Farm Health Benefits Plan (the Plan ), to help you comply with various Federal and state Bureau Health Benefits Plan (the Plan ), to help you comply with various Federal requirements applicable to employers offering health coverage and other benefits to their and state requirements applicable to employers offering health coverage and employees and their family members. other benefits to their employees and their family members. R e f Compliance Requirement or Feature Time of Hire OFB Health Benefits Plan Participating Employer Compliance Guide 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 MMS 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 Children's Health Insurance Progam Reauthorizatio D Employee Notice - Enrollment At enrollment time Employer 8 Summary of HIPAA Privacy Notice D Employee Notice - Enrollment At enrollment time Employer 9 OFB HBP Plan Document E OFB HBP provides Enrollee requests Employer 10 Summary Plan Description ("SPD") Plan 501 F OFB HBP provides 90 days post enrollment Empoyer 11 Summary Plan Description ("SPD") Plan 502 F OFB HBP provides 90 days post enrollment Employer 12 Summary Annual Report ("SAR") G Plan provides, Employer distributes 9 months post plan year end Employer 13 Individual Mandate Sec 6055 Form 1094 H Employer prepares tax form See IRS Guidelines n/a 14 Medicare Primary Registration - Employer I Employers < 20 E's register When Employer < 20 E's n/a 15 Medicare Employee Registration I Employees eligible for Medicare When Employer < 20 E's Employer 16 Non-Discrimination J Employers must not discriminate Continuously n/a 17 Summary of Modification ("SMM") K Plan provides, Employer distributes 210 days post plan year end Employer 18 Summary of Material Reduction ("SMR") L Plan provides, Employer distributes Within 60 days of change Employer OFB HBP Compliance Guide v.6 - Copyright 2016 Consoliplex 27

28 Other Compliance Requirements and Responsibilities R e f N o t Who Distributes Document Compliance Requirement or Feature e Comment When (1) 19 Employer Mandate Sec Form 1095 H Plan does not target employers >50 e. Employer Files Return n/a 20 Notice of Benefit Determination M MMS provides in EOB EOB is delivered to enrollee Anthem 21 Internal Claims Appeal Process N OFB HBP provides in SPD Enrollee appeals Employer 22 External Claim Review Process N OFB HBP provides in SPD Enrollee appeals Employer 23 Qualified Medical Support Order N OFB HBP Provides in SPD SPD is provided Employer 24 Childrens Health Insurance Program (CHIPR") N OFB HBP Provides in SPD SPD is provided Employer 25 Newborn Mother's Health Protection ("NMHPA") N OFB HBP Provides in SPD SPD is provided Employer 26 Michelle's Law - College Students N OFB HBP Provides in SPD SPD is provided Employer 27 Womens Health Cancer Rights Act ("WHCRA") N OFB HBP Provides in SPD SPD is provided Employer 28 Mental Health Parity Addiciton Equality ("MHPAEA N OFB HBP Provides in SPD SPD is provided Employer 39 Genetic Informaiton and Nondiscrimination N OFB HBP Provides in SPD SPD is provided Employer 29 Notice of Granfathered Status - Plans are not grandfathered n/a n/a 30 Form M-1 O OFB HBP files March 31st and special times n/a 31 Form 5500 P OFB HBP prepares and files Form 5500 is filed n/a 32 Notice of Pre-Exisiting Coverage Notice - Not needed, guaranteed issue n/a n/a 33 Benefit Book - Medical Plans B Included as a SPC section SPD is provided Employer 34 Summary HIPPA Privacy Notice D Employee Notice - Enrollment At enrollment time Employer 35 HIPPA and State Privacy Practices P Employee Notice - Enrollment Employee request Employer 36 HIPPA Privacy and Security Policy Q OFB HBP Provides on Request Employee request Employer 37 Privacy and Security Officer Q OFB HBP provides Notice and SPD SPD and Notice provided Employer 38 Business Associate Agreeement Q OFB HBP provides to associates When contract signed n/a 40 Notice of Minimum Essential Coverage B All Plans are minimum essential SBC is provided Employer 41 Minimum Value Determination B All Plans are minimum value SBC is provided Employer 42 Aggregate Cost of Employer Sponsored Benefit Q Not required for Employers <200 PE prepares W-2 n/a 43 PCORI Fee - OFB HBP pays OFB HBP files return n/a 44 State Premium Tax - NA for self-funded plans. Not applicable n/a 45 Transitional reinsurance fee - OFB HBP pays OFB HBP notifies CMS n/a 46 Preparation of Form OFB HBP files OFB HBP files with IRS n/a 47 NAIC Annual and Quarterly Statements - OFB HBP files Per ODI requirements n/a Initially you should note the compliance documents are located in in the OFB HBP Zone website maintained by FormFire. Your insurance agent will help you access this website. FormFire has been engaged as as the enrollment manager for for the OFB HBP Zone. You must go to the OFB HBP Zone to access the various documents that you need to 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 OFB HBP Compliance Guide v.6 - Copyright 2016 Consoliplex 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. 28

29 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. 29