Quality health insurance at affordable rates – this is what ODA members have been asking for

Finding affordable health insurance coverage without having to sacrifice quality is an enormous challenge for dental offices. Ohio Dental Association members have been asking the association to provide an alternative to buying high-cost health policies through the government exchanges (Affordable Care Act).

A MEWA (multi-employer welfare trust) is a vehicle that allows small employers such as dentists to come together to create their own health insurance plan in order to control costs and better manage benefits. A MEWA must be established by an association, so the Ohio Dental Association through its subsidiary the ODA Services Corp. Inc. has applied to create its own health care trust.

The Ohio Dental Association Wellness Trust (ODAWT), once it is approved by the Ohio Department of Insurance, will be a private, dentist-owned, self-funded health benefit plan. This plan has been exclusively developed for member dentists and their staffs to help battle the increasing cost of providing health care benefits and to provide access to health care plans outside the ACA. The Ohio Dental Association Wellness Trust will be open to all member dentists and their employees. Approval is expected in the next several months.

Self-funded strategies offer three primary advantages.

  • Greater control over plan design – the ODAWT can design its own plans and deductibles options, avoiding some of the ACA’s mandates.
  • Greater control over plan operation – self-fund plans can choose their own networks, providers and features.
  • Ability to control costs and keep rates low – a major cost-saving feature is that the ODAWT does not have to pay the state insurance premium tax and avoids paying many of the ACA’s mandated taxes.

According to industry research, a typical self-insured group can expect to save more than 10 percent (versus traditional health insurance) without having to sacrifice quality of care.

While the ODAWT’s benefits are not guaranteed by a traditional health insurer, its plans, coverage and providers will be the same as the currently sponsored plan (Dentists’ Choice Healthcare Plan), which is scheduled to end in 2015 because of the health care reform legislation.

All self-funded plans have some level of risk that arises from unexpected catastrophic claims or the timing of the claims. Even the very largest of self-insured plans are not comfortable with that scenario. The solution is for the plan to re-insurance that possible risk by purchasing stop-loss coverage. The ODAWT has stop loss insurance to mitigate this inherent risk. The actuarial study done by the ODAWT estimated that there is less than a 0.5 percent chance that the Trust would be impacted by a catastrophic claims situation.

For those offices currently enrolled in the DCHCP, ODASC staff will be in contact to assist in rolling over the office to the new plan once the trust is approved by the Ohio Department of Insurance. The differences in the plans are minimal so subscribers will notice no differences. The ODAWT has contracted with Medical Mutual Services in order to keep the same providers and hospitals that currently serve ODASC’s fully insured group. All plans and deductibles will remain the same including the premiums. The ODAWT premiums for current subscribers are guaranteed through the end of 2015, effectively giving them 17 months without a rate increase. ODASC will be contacting all current subscribers to explain the transition and answer any questions.

Other member offices interested in insuring through the ODA Wellness Trust should keep watching for the announcement of the approval of the ODA Wellness Trust.