O.C.A. Executive Summary
For more than 20 years, O.C.A. Benefit Services, LLC (O.C.A.) has been a leader in the employee benefits arena with a commitment to customer service through creative and cost efficient benefit plan designs. We are not just an administration company, but rather an “Employee Benefits Delivery Organization” established to provide employers, agents, brokers, and plan participants with the most cost efficient and effective benefit packages available.
We believe that quality healthcare is actually less expensive to deliver than poor quality healthcare.
While we recognize the very nature of human behavior is to resist change, we also need to embrace the reality that Consumer Empowered Health Plans (CEHP) are the cure to rising health care costs and poor quality health care delivery. Our approach is candid, open, and honest. We believe in setting fair and reasonable expectations with all the parties involved.
We understand that keeping the process easy is critical to the implementation of the program, but we also understand that sacrificing compliance will eventually catch up with a client in direct or hidden costs. Our role is more than just a Third Party Administrator, but as a portal of reliable information and education. The Plan Participant will once again seek the rewards of being a consumer of health care.
O.C.A. Benefit Services offers a complete suite of Administrative Services including the following:
Ø Plan Design Consultation
Ø Cafeteria Plan Administration (POP/FSA/DCAP)
Ø Transportation & Parking Administration
Ø HRA Administration
Ø HSA Administration
Ø COBRA Administration
Ø Electronic Payment Cards (MySource Card)
Ø Wellness
Ø 24/7 Secure Web Portal and I.V.R. Phone System
Ø Employer Compliance Reporting
Plan Design Consultation
Plan design is the first, and probably most important, step in creating an effective employee benefit program. Each worksite situation is unique, so the key is to design a plan to achieve your specific goals.
The options can seem endless, and understanding your needs is the best place to start. Whether you choose plans that are fully-insured, self-insured, company provided, traditional, or consumer-driven, O.C.A. representatives have proven and effective skills to develop an ''employee benefit strategy'' that reflects your organizational objectives.
For instance, you may want to offer an FSA, HRA, or HSA as a standalone plan. Or you may see the benefit of stacking the plans to include a combination of the three. You may even offer a ''menu'' of plans from which your employees can choose.
O.C.A. Plan Design Services include:
1. Complete analysis of your benefit program
2. Establish a goal for the plan, ex: benefit coverage, cost savings
3. Plan formulation to provide a variety of options for your employees
4. Final Plan Design
5. Provide customized on site education to all employees
What is a Health Reimbursement Arrangement?
A Health Reimbursement Arrangement (HRA) is an employee benefit plan designed to help offset unreimbursed medical expenses incurred by the employee (and dependents). The employer provides the funds to reimburse the employee by contributing funds to an HRA. After the expenses are incurred, the employee can submit a claim or use a health debit card for reimbursement.
HRAs can vary greatly in design, but are developed basically for the same purpose—to reimburse the employee for expenses not covered by any other health plan. For example, one HRA can be designed to cover all or a portion of the deductible on a High Deductible Health Plan (HDHP), while another is designed to reimburse the employee for dental and vision expenses. It just depends on the employer's goals for providing employee benefits.
An HRA can be "linked" or "unlinked." A linked HRA is tied to a health plan; you have to participate in the health plan to be eligible for the HRA. An unlinked (or stand-alone) HRA is set up to pay certain expenses, such as dental or vision expenses, without any connection to an insurance policy.
Advantages of HRAs for employers:
· Qualified reimbursement claims are tax deductible for the employer.
· Employers know their maximum expense and cost to their health care benefit.
Advantages of HRAs for employees:
· If the employee pays for a qualified medical expense, the reimbursements may be tax free.
· Unused funds in the HRA can be rolled over to the next year for reimbursement.
· HRAs can be offered with another employer-based health plan like a Flexible Spending Account.
· Employees do not have to be covered under any other health care plan like a High Deductible Health Plan to participate.
· Contributions made by the employer can be excluded from employees' gross income.
· HRAs can be tailored to meet the employees' needs or to their families' specific needs, as opposed to a standard company-wide plan.
An HRA gives employees additional choices and greater control over health care expenses, and provides them with financial assistance when they incur an eligible medical expense. Also, HRAs give the employee the option of selecting the health plan that is right for them. Health Reimbursement Arrangements do not limit your access to healthcare or prevent you from going to the doctor in anyway.
Who can participant in an HRA?
Under an HRA, self-employed individuals (e.g., sole proprietors, LLC, partners in a partnership, and greater-than-2% Subchapter S corporation shareholders) may not receive tax-free benefits.
Self-employed individuals, including partners in a partnership and more-than-2% shareholders in an S corporation, cannot participate in an HRA on a tax-favored basis. Further, certain family members of more-than-2% S Corporation shareholder may not participate in an HRA. As an S-corporation, you can have an HRA for your common-law employees, but unlike in a sole proprietorship or a partnership, neither the employee-spouse of the more than-2% shareholder in an S corporation nor the more-than-2% shareholder's children, parents, and grandparents, can participate in the HRA. This is because of the ownership attribution rules contained in Code §318.
O.C.A. HRA Administrative Services:
· Preparation of plan documents
O.C.A. will create a customized legal document outlining the provisions of an employee benefit plan.
· Annual discrimination testing and necessary information provided for employers to complete their 5500 forms
Annual discrimination tests are designed to show that eligibility and plan benefits are applied fairly and consistently, which in turn allows the plan sponsor to avoid unfavorable tax consequences.
· Customized employee communication material
Whether it’s a group of two or a group of five hundred, O.C.A. will create customized employee communication material based upon the groups plan design. O.C.A. provides industry expertise with top of the line representation. We represent our clients by educating and assisting employers, employees and their families.
· Client Customer Service
At O.C.A. Benefit Services, we don’t just process claims, we work towards educating individuals on the impact they can have on the cost and quality of health care. We are committed to our client relationships and it shows from the effort we put forth that our clients’ needs are professionally, courteously and personably satisfied. The member service department is open from 9:00 am to 5:00 pm Eastern time Monday through Thursday and
until 4:30 pm Eastern time on Friday. O.C.A. also provides members 24/7 access to account balances through our website as well as our 24/7 access thru our Interactive Voice Recognition Phone System (IVR).
· Daily claim adjudication processing
With O.C.A. Benefit Services, claims are typically processed within 48 hours of receipt. All claims are 100% manually audited.
· Direct Deposit of claim payments
Direct deposit of employee claims is efficient, environmentally friendly, and saves money. Imagine submitting a claim in to O.C.A. Benefit Services at 9:00 a.m. and having that claim processed either the same day or at the latest, the next business day. Once processed, the funds hit the Federal Clearing House which typically clears in two to three business days. Once cleared, it will then hit your bank to clear for deposit. You are then free to access those funds to pay your provider for the services that were rendered. For an additional small fee, O.C.A. will pay providers directly on the employee’s behalf.
Electronic Payment Card (mySource Card) for HRA/FSA plan design
Electronic payment cards are becoming more prevalent and vital in a successful benefit plan offering. Introducing an electronic payment card into a reimbursement account plan empowers employees and gives them an option to avoid inconvenient out-of-pocket expenses.
Card Services provided:
ü Initial card enrollment and account set up
ü Initial delivery of cards to employer by overnight mail
ü Transaction monitoring and reconciliation
ü Customer service to employees
· Health Debit Card Regulations (mySource Card)
The Federal government requires certain debit card transactions be substantiated via the submission of necessary supporting documentation that supports the charge. If supporting documents are not provided (typically within 30 days of the swipe), these regulations require the card be “timed-out” (temporarily suspending the use of the card) until said documents have been provided to O.C.A. Benefit Services. There are claims that will “auto substantiate” without the need for submitting documentation and want to identify those rules to eliminate confusion and frustration.
O.C.A’s mySource Debit card will work and auto-substantiate at vendors (i.e. CVS, Walgreens, RiteAid, etc) that have gone through a certification process (referred as I.I.A.S.).
This certification process itemizes expense as deemed eligible under IRS Code 213(d), which is the complete list of FSA approved expenses.
It is also important to know that mySource Debit Cards are also able to be used at merchants such as doctor’s office, dentist, optometrist, hospital, and others. However, these approved locations (merchants) were exempt from the same requirements that govern the certification process that the vendors went through (IIAS). That said, using the mySource Debit Card at these locations will almost (with few exception) always require supporting documentation be submitted.
Employer and employee access to a 24/7 secure web portal
Employers and their employees will have 24/7 access to our secure web portal called Myrsc (My Resource Center). Myrsc provides each user a customizable view based on whether the user is the employee, manager, employer, human resource administrator, payroll processor, benefit consultant, plan service provider, insurance carrier or any person with appropriate access permissions and role authority. As an example, employees will have the ability to enter/submit claim forms online, view benefit history, access debit card activity, and much more! The single most distinctive characteristic of the site is its adaptability and its ability to fit the purpose of any user.
(XX Lives)
Requested Quote for HRA Administration
Services / Set Up/Takeover / Annual Fee / Rate PerPar/Per Month / Total Monthly Cost / Total Annual Cost
· HRA
· Debit Cards
· FSA(Inclusive in proposed fee)
· Direct Deposit / $XXX.00
Est.@ XXX
Participants / $X,XXX.00
(Includes $500 Annual Fee)
Additional Service Fees May Apply
Paper Check Reimbursement / $1 Per Check IssuedPay Provider Option / $3 Per Check Issued
For additional information please contact:
O.C.A. Benefit Services Sales Department
(609) 514-0777 or
3705 Quakerbridge Road, Suite 216
Mercerville, NJ 08610