Why Choose O.C.A. Benefit Services
1. We focus our attention on Consumer Education. TPA HRA fees
represent .75 – 1.5% of the average health plan’s overall
cost.
By focusing our attention on impacting the remaining
98.5%,
we find that our value proposition places us as the true, lowest cost
TPA provider. We seek to show our clients that quality
health care is actually less expensive to deliver than poor quality
health care. In doing this, the end result is that we get
consumer “buy-in” on a quality proposition where everyone wins.
Employers and employees spend less in claims and the employee is
healthier and more productive in the long run! Those lower claims
payments are directly reflected in lower HRA utilization that with
O.C.A., leads the industry.
2. Our Debit
Card process is in full compliance with
IRS guidelines
If the plan’s Third Party Administrator (TPA) allows the card to be
used in an “open environment” where all I.R.S. Section 213(d) eligible
expenses are approved at point of purchase, employers may be funding a
substantial amount of ineligible expenses. Under the IIAS system,
eligible 213(d) expenses are coded as either Category 11 (prescriptions
only) or Category 10 (all other eligible medical expenses such as
Contact Lens Solution or Band-Aids). When a TPA includes Category
10 in the HRA arena, the employer is likely funding a fair amount of
ineligible transactions. Without proper adjudication on the back
end, the employee may feel that the card is a great tool and easy to
use. In addition, the employer will feel the card is helping to ease
the transition into the CDHP plan design. The problem with this
approach is that inevitably it increases the employer’s claim costs
that do not show up until the following year. It’s not until the TPA
presents the “Unsubstantiated Debit Card Transaction” report detailing
total dollars that must be added back to each Employee’s W-2 as taxable
income, in which the employer also pays their portion of FICA that the
“leakage” shows up.
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At O.C.A., our approach serves to maintain compliance with I.R.S.
guidelines to save the employer from significant ineligible debit card
transactions. We do this through our rigid compliance standards
and belief that communication is critical to the success of a CDHP plan
At set-up, we suggest that with the HRA platform, debit cards are coded
for Category 11 only to ensure only eligible expenses get
approved. By limiting the charge to Category 11 only, common
over-the-counter items, dental fees, optometrists’ fees, etc., will
never be approved at point of purchase with a debit card. If the
employer wants to allow all 213(d) transactions on the HRA card, we
monitor card activity and require paperwork to substantiate purchases
when necessary. If the participant does not provide proof of
purchase within a pre-determined window, we “time-out” their card until
proof is provided thus, eliminating additional misuse of the
card. Additionally, we provide customized communications for
every account explaining proper use of the card in user-friendly
language
3. We believe in the next
generation of CEHP- (Stacked HSA/HRA) with a
“Turbo charged FSA”
As the nation’s leading TPA focused on Consumer Empowered platforms,
O.C.A. Benefit Services has focused its attention beyond its ultrafast
processing time and looked to creative plan techniques designed to
foster positive behavioral changes. By partnering with O.C.A Benefit
Services, your brokers and their clientele can be at the forefront of
successfully instituting the next generation of Consumer Empowered
Health Plans, the “stacked HSA/HRA”.
With the customization of these unique plan designs, we can effectively
work around the 10% “premium tax” being applied by certain carriers who
find their HRA plans to be funding greater than 50% of an employee’s
medical deductible. By implementing the “stacked HSA/HRA” plan design,
employers will not only have the ability to maintain cost, but they
will also have the comfort of offering high level benefits to their
employees. We address the legitimate concerns and needs of having
employees “skin in the game”.
Please see below an example of what we believe is the next wave of
Consumer Empowered Health Plans.