Frequently Asked Questions
Who is eligible for the SOCA Benefit Plan?
The SOCA Benefit Plan is available to small business employers that have at least two employees enrolled on their medical plan and no more than 50 total employees. The business must be domiciled in Ohio, and must be a member in good standing with a Chamber of Commerce that is qualified to offer the SOCA Benefit Plan.
These chambers include:
- Southern Ohio Chamber Alliance (SOCA)
- Northern Ohio Area Chambers of Commerce (NOACC)
- Central Ohio Chambers of Commerce (COCC)
- Dayton Area Chamber of Commerce (DACC)
- Youngstown/Warren Regional Chamber (YWRC)
Why Anthem Blue Cross and Blue Shield?
Get peace of mind knowing that Anthem has been serving millions of members in Ohio for more than 75 years and is:
- Part of the nation’s largest health benefits company
- Part of the BlueCard® program through the Blue Cross Blue Shield Association, which includes more than 96% of hospitals and 93% of doctors in the country
- Highly experienced in alternate funding plans
What is a MEWA?
A MEWA is a multiple employer welfare arrangement. It is an employee welfare benefit plan, trust or other arrangement that is established or maintained for the purpose of offering group insurance. It is governed by Trustees and By-Laws that satisfy the Ohio Department of Insurance (ODI) requirements.
How will the SOCA Benefit Plan pay our employees’ claims? Will they have the funds necessary?
The initial capital requirement is $500,000. This requirement has been satisfied. The ODI increased this requirement from $150,000 with the objective to protect consumers. There is quarterly adequate risk based capital monitoring by the ODI of the Plan. In addition, Anthem is providing additional reinsurance protection under a quota share arrangement on top of the specific and aggregate stop loss coverage provided.
Who makes the decisions for the SOCA Benefit Plan?
The SOCA Benefit Plan Board of Trustees will be responsible for the oversight of the Plan and ensuring that the Plan complies with all applicable laws and regulations.
Why would we choose a MEWA over an ACA policy?
This alternative self-funded solution could be a good fit for you for many reasons including:
- Competitive rates
- Rating methodology similar to pre-ACA rating
- Predictable, fixed monthly payments
- Protection of being part of a larger self-funded pool backed by Anthem’s stop loss
- Anthem’s broad Blue Access PPO network
- Flexibility in choice of benefit plans
How do we determine if we are eligible to participate?
The SOCA Benefit Plan is available to small business employers that have at least two employees enrolled on their medical plan and no more than an average of 50 total employees. The business must be domiciled in Ohio and must be a member in good standing with a Chamber of Commerce that is qualified to offer the SOCA Benefit Plan.
These chambers include:
- Southern Ohio Chamber Alliance (SOCA)
- Northern Ohio Area Chambers of Commerce (NOACC)
- Central Ohio Chambers of Commerce (COCC)
- Dayton Area Chamber of Commerce (DACC)
- Youngstown/Warren Regional Chamber (YWRC)
Do we need to meet certain participation and contribution requirements?
Yes. At least 75% of the Net Eligible Employees and a minimum of two employees must be covered under the Plan. The minimum employer contribution is at least 25% of the total cost for health benefits chosen in the event the employee has dependent benefits, and at least 50% of the total cost for health benefits in the event the employee has single benefits. If you contribute 100% of the premium equivalent, 100% of the net eligible employees must enroll.
Can we join the SOCA Benefit Plan at any time during the year?
Yes, however, all participating employers in the SOCA Benefit Plan renew on May 1 of every year.
How will my premium equivalent rate be determined?
There are multiple factors that impact your premium equivalent rate including:
- Medical history and expected risk of your employees’ future health claims
- Age and gender of your employees
- The number of employees enrolled on the benefit plan
- Where your company is located
- Benefits that are being offered
What components are included in my premium equivalent rate? Are there other amounts that we have to pay in addition to the premium equivalent rate?
Your premium equivalent rate covers expected claims, administrative expenses, taxes and assessments, and stop loss premium. In addition, chamber membership dues and product dues are required to be paid. These amounts are paid to the chamber that you are a member of and the SOCA Benefit Plan, respectively.
How will the annual renewal increase be determined?
An overall renewal increase needed for the SOCA Benefit Plan will be calculated based on a projection of the claims for the upcoming policy year for the entire SOCA Benefit Plan. Each participating employer’s increase will then be calculated based on that employer’s specific claims history and risk profile, as well as any changes in the demographics and number of enrolled employees of the group.
Can we terminate our policy at any time?
During the policy period, you may only elect to withdraw from the MEWA as of the end of a calendar month by giving written notice at least 60 days prior to that date. At renewal time, you must give written notice at least 30 days in advance.
We currently have an Anthem Blue Cross and Blue Shield policy. Will our employees have to change their doctor?
The SOCA Benefit Plan uses Anthem Blue Cross and Blue Shield’s Blue Access health care provider network – one of the largest provider networks in state. You should, however, always check to make sure doctors are in-network prior to any service using the “Find a Doctor” tool.
Are there dental, vision and life options available?
Yes, participating employers in the SOCA Benefit Plan are eligible for discounted ancillary plans offered by Anthem. This includes dental, vision, life and disability. These are stand-alone, fully insured plans for which the participating employer contracts directly with Anthem.
