Remember Your Health Insurance ABCs

Knowing how to manage your healthcare plan can save you and your business time and money. Whether you’re looking to join a COSE MEWA plan through Medical Mutual or have been a member for years, it is important to review your plan information periodically to make sure you are getting the most out of it. Here are a few tips to get you started.

A – Amounts matter
How much you pay for different services throughout the year can depend on what you’ve already spent in relation to your plan’s deductible and other key amounts. Here are some simple explanations for the amounts you typically need to know and how they work.

Copay: These are the flat fees you pay each time you go to the doctor or fill a prescription. Copays do not count toward your deductible.
Deductible: This is what you will pay per year for medical bills and prescriptions before your healthcare plan starts sharing the cost. Once you meet your deductible, your costs are determined by your plan’s coinsurance.
Coinsurance: This is the set percentage of your medical expenses you will pay after you reach your deductible. You pay this percentage until you reach your plan’s out-of-pocket limit.
Out-of-pocket limit: This is the limit for how much you will pay per year for services covered by your plan. Once you reach this limit, all covered services are paid by Medical Mutual at 100%.

Remember, only services that are covered by your health plan will count toward these amounts.

B – Browse your plan benefits 
Before you have a service or procedure, be sure to review the benefits covered by your plan. There are two documents you can use to understand your benefits—your Summary of Benefits and Coverage (SBC) and your Medical Plan Description (MPD), which explain your plan’s costs, benefits, healthcare services and more.

C – Compare costs
Medical costs can vary based on several factors—like having the same test at a different location. Medical Mutual offers My Care Compare, an online tool to help you evaluate how different factors may affect costs for a wide range of medical services. It’s especially important when you need lab tests, which may be subject to your plan’s lab Coverage Maximum.

D – Don’t go out of network
Services performed by in-network healthcare providers usually cost significantly less than those that aren’t. In fact, some services may not be covered at all when you use a non-network provider. Always take the time to make sure your provider is in your network before you schedule a treatment or procedure.

E – Engage online

My Health Plan, Medical Mutual’s secure member website, helps you easily keep track of claims and deductible amounts. It's also where you can review your Explanation of Benefits (EOB) statements after you have services.

If you are a COSE MEWA member through Medical Mutual, creating your My Health Plan account is simple. Just visit MedMutual.com/Member and click Register for an Account. To learn more about other benefits offered through a COSE MEWA health plan, please contact your broker or your Medical Mutual Sales representative. 

 
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  • Next up: Reporting for Reform - How to Comply with Upcoming IRS Reporting Requirements
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  • Reporting for Reform - How to Comply with Upcoming IRS Reporting Requirements

    As part of healthcare reform, the Internal Revenue Service (IRS) added sections 6055 and 6056 to the Internal Revenue Code. Starting in 2016, the IRS requires insurance companies to collect any missing Social Security numbers for members and dependents covered by fully insured health plans. “Typically, insurance carriers have only needed employees’ Social Security numbers, not those of spouses or dependent children,” says Patricia Decensi, General Counsel at Medical Mutual. “However, the IRS will soon require that information to verify that everyone in the United States is covered.” The information will be used to enforce the part of healthcare reform that says everyone in the United States has to have health insurance—or qualify for an exemption. In addition, it will allow the IRS to verify whether certain employers offer “minimum essential coverage” for their employees. The requirements are based on two key factors. 

    As part of healthcare reform, the Internal Revenue Service (IRS) added sections 6055 and 6056 to the Internal Revenue Code. Starting in 2016, the IRS requires insurance companies to collect any missing Social Security numbers for members and dependents covered by fully insured health plans.

    “Typically, insurance carriers have only needed employees’ Social Security numbers, not those of spouses or dependent children,” says Patricia Decensi, General Counsel at Medical Mutual. “However, the IRS will soon require that information to verify that everyone in the United States is covered.”

    The information will be used to enforce the part of healthcare reform that says everyone in the United States has to have health insurance—or qualify for an exemption. In addition, it will allow the IRS to verify whether certain employers offer “minimum essential coverage” for their employees.

    The requirements are based on two key factors.

    First is the funding structure of the health plan. Some employers are self-funded and pay their own claims, while others are fully insured through their carrier. The funding structure determines whether employers have to do their own reporting under Section 6055, the individual mandate.

    Second is the number of full-time employees. Section 6056, the employer pay or play rule, only applies to employers with 50 or more full-time employees. That includes full-time equivalents. Those employers will have to report to the IRS in early 2016 to prove they offer health coverage that complies with healthcare reform. And that applies even if they were exempt this year.

    “Fully insured employers can rely on their insurance carrier to report for them for 6055, and they will only need to report for 6056 if they are subject to pay or play,” Decensi says. “Self-funded employers, on the other hand, are responsible for all reporting to the IRS, regardless of pay or play.”

    All fully insured employers should work with their carrier to understand their responsibilities, according to Decensi. Insurance companies are obligated by law to reach out directly to employees if the required information is still missing. Plus, those employees or dependents could end up seeing money come out of their next year’s tax return if their coverage isn’t verified.

    Medical Mutual is planning to reach out to its fully insured customers, including those enrolled in COSE plans, to let them know who is missing Social Security numbers. Self-funded customers are encouraged to consult with their tax advisor or legal counsel.

    “Our goal is to comply with the new rules while keeping the impact on our members to a minimum,” says Decensi.

    COSE members with questions about the new requirements should contact their broker or call the COSE Benefits Group at (440) 878-5930. They should also watch for webinars from Medical Mutual later this fall about the actual forms and steps to take for reporting. 

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  • Next up: RITE HR IT Roundtable - Measuring the Immeasurable
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  • RITE HR IT Roundtable - Measuring the Immeasurable

    Watch our discussion exploring HR-related frameworks to assess your strengths and opportunities and how to capitalize on data to get the buy-in you need for your HR initiatives.

    The most recent RITE HR IT Roundtable featured Michelle Leighton, Chief Talent Officer at Lifebanc. Michelle has over 20 years of Human Resources and Organization Development experience across various industries, including manufacturing, banking, insurance and healthcare. Her proven leadership in talent management, development and business acumen earned her an HR Business Leader Award in 2016.

    Michelle explored a framework for leveraging creative data capture and analysis to optimize investments in sourcing, interviewing, on-boarding, development, and retention that enable competitive advantage in the marketplace. 

    Watch the presentation below:

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  • Next up: Safety Council Recap: 5 Questions to Ask About Your Business
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  • Safety Council Recap: 5 Questions to Ask About Your Business

    Security prevention and response is more important than ever. Here are five security-related questions attendees of the July 12 COSE Safety Council were asked to consider.

    Corporations today have a greater need to be more cognizant and proactive about physical security prevention and response for their businesses. This is more important today than ever in the history of America. The COSE Safety Council provided a unique presentation to address these issues at their July 12 Safety Council meeting.

     

     

    Here’s an overview of what was discussed.

     

    Tim Dimoff and SACS Consulting delivered the first segment by explaining the current security threats that now play into the many different businesses in America. After Dimoff’s presentation, five security-related companies explained cutting-edge counter solutions to the growing security exposures.

     

    These experts discussed the following five points: 

    1. Has your company recently conducted a complete security assessment? 

    2.Have you determined what are the most likely security risks that you face? 

    3. Do you have a strong keying or card access system? What are the advantages to each? 

    4. What non-lethal defense mechanisms can you access?

    5. What are the top three cyber security threats and how can you prevent them?

    In conclusion, it makes sense for all businesses to proactively update their preventive defensives to today's security threats. 

     

    Learn more about COSE’s Workers’ Compensation program by clicking here

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  • Next up: Safety Council Recap: 5 Steps to Take After a Serious Workplace Incident
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  • Safety Council Recap: 5 Steps to Take After a Serious Workplace Incident

    Attorney and consultant William Haak spoke to the Northeast Ohio Safety Counsel Aug. 9 concerning serious workplace incidents (and how to ensure things go right after they've gone horribly wrong). Haak, the founder of environmental, health and safety legal and consulting firm Haak Law LLC, has more than 23 years of environmental experience and 17 years of occupational safety experience.  During his presentation, he provided real world examples of workplace crises and how employers should respond to protect their people, their business, and the communities surrounding their facilities.

    According to Haak, serious workplace incidents include:

    1. Injuries and fatalities;
    2. fires, explosions, and other accidents;
    3. workplace violence;
    4. spills or releases of hazardous substances;
    5. severe weather incidents; and
    6. incidents that might not seem "serious" that become serious because of social media such as Twitter, Facebook, or Instagram

    The above-listed incidents could strike at any business regardless of size. Preparedness and knowing exactly what to do before a serious incident occurs is the key to success.

    Haak recommends having policies and procedures in place to guide your business through what he refers to as "the Serious Incident Golden Hour"—the first 60 minutes after a serious incident occurs. In addition to protecting life (including employees, visitors, etc.), protecting your property and assets, and securing the scene along with first responders such as police and fire personnel, it is important to:

    1. Establish an incident commander and an incident command post;
    2. begin early stages of an incident investigation to determine what went wrong;
    3. preserve the scene (for investigation) and collect evidence and witness statements;
    4. make required notifications to regulatory agencies such as EPA and OSHA; and
    5. communicate any facts you know to interested stakeholders including superiors and subordinates, first responders, the community (the media), and impacted family members

    All of these important steps can—and should—be practiced in routine crisis drills. Carefully crafted crisis drills can provide important insights into the strengths and weaknesses of your crisis response plans.

    Finally, as an attorney, Haak advises legal counsel be involved early on for more serious incidents.  Legal counsel can assist your incident commander in many tasks including making regulatory notifications and developing talking points. An attorney with the right background and experience can also help lead your incident investigation. Most importantly, involvement of legal counsel can help establish the attorney-client privilege (which can provide you with some important protection should an incident lead to litigation).

    For more information, please contact William Haak of Haak Law LLC at whh@haaklawllc.com or 216-772-3532.  You can also visit www.haaklawllc.com.

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  • Next up: Save Money on Lost Time Claims: Open Enrollment Continues Through May 28
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  • Save Money on Lost Time Claims: Open Enrollment Continues Through May 28

     

    As a Managed Care Organization (MCO), it is 1-888-OhioComp’s responsibility to ensure that injured workers receive the best treatment and return to work safely while minimizing the financial impact to you, the employer.

    There are more than 91,000 Active Lost Time claims currently managed by the 10 MCOs in Ohio. Lost Time claims are the most expensive claims and have the greatest impact on an employer’s premium.

    The Active Lost Time claims managed by 1-888-OhioComp have the:

    - Lowest Claim Costs for Lost Time claims of any MCO
    - Lowest Medical Costs for Lost Time claims of any MCO
    - Lowest Indemnity Costs for Lost Time claims of any MCO
                                                       Data Source: BWC report Sp20-004427 (12/18/20)


    Open Enrollment for workers’ compensation Managed Care Organizations (MCO) continues through May 28. COSE and Greater Cleveland Partnership (GCP) endorse and recommend 1-888-OhioComp as the preferred MCO for our members.

    During the month of May, many Third-Party Administrators (TPAs) try to confuse employers and have them sign an AC-3 and an MCO enrollment form. An AC-3 will get you a quote for TPA services and does not obligate you; a signed MCO enrollment form automatically switches you to their MCO.

    Be careful what you sign in May.

    To select 1-888-OHIOCOMP as your MCO, just click the link and fill out the form and return it to us by May 28. It couldn’t be easier! There are no costs for our services. If you have any questions or want to schedule a meeting (virtual or in-person), please call us at 1-888-644-6266. 

    Enrollment forms received after 5 p.m. on May 28 cannot be processed. Please fax the form to 216-446-6100 or email enroll@1-888-ohiocomp.com.

    Enrollment Form

    Claims Management

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