The Consumer Page: SB 1621 an option for small businesses
BY PHIL MULKINS World Action Line Editor
Wednesday, September 19, 2012
9/19/12 at 3:44 AM
On June 28, Oklahoma Insurance Commissioner John D. Doak announced in the OID website's "Commissioner's Corner" ( tulsaworld.com/DoakonObamaCare) that he was "disappointed with the Supreme Court's decision to uphold 'Obamacare' but will do his duty under the law. Potential legal challenges remain, namely on the issues of religious freedom and 'navigators.' A one-size-fits-all big government policy creates more problems than it solves," he stated.
"The mandates increase costs for employers, insurance companies and consumers. They also compromise religious freedoms. The federal government shouldn't be interfering in the private lives of Americans. We can reduce health costs without compromising freedom and access to care with conservative polices like 'association health plans' and being able to purchase insurance policies across state lines.
Oklahoma Senate Bill 1621: The bill ( tulsaworld.com/SB1621) signed into law by Gov. Mary Fallin on April 25 made it possible for many of Oklahoma's small businesses to buy group insurance through "employer associations" which can pool resources with like businesses.
Small Employer Health Insurance Reform Act: Insurance Commissioner Doak said SB 1621 "greatly strengthens Oklahoma's business environment by allowing industry associations to offer large group policies to small employers. Authored by Rep. Glen Mulready, R-Tulsa, and Sen. Bill Brown, R-Broken Arrow, the bill requires associations to meet the federal guidelines of a "bona fide" association ( tulsaworld.com/BonaFideAssn). The bill is codified Title 36, Section 6513 - the "Small Employer Health Insurance Reform Act," or SEHIRA. It becomes effective Nov. 1, 2012.
Health Insurance basics
The Oklahoma Insurance Department website has a section on "Health Insurance Basics" at tulsaworld.com/OKHealthInsBasics and it addresses insurance questions.
Group coverage: A group insurance policy may cover two to thousands of people, but it is still only one policy. Employers or associations are master policyholders and group members are certificate holders. Each family member covered under your certificate is insured. The master policyholder negotiates group policy terms with the insurance company.
Master policyholder: Can reduce or change benefits and coverage, increase your share of the premium, switch to another insurance company or stop providing coverage.
Group contract: Rates for employer groups are negotiable and are not regulated by OID except in the instance of small group insurance. The contract must include specific minimum benefits required by state law - other benefits are negotiated by the master policyholder. The MP does not need consent of certificate holders to change companies or policies, cancel the policy or agree to new premiums or benefits.
Large and small employer group contracts: May cover more conditions than individual contracts, may have more generous benefits and cannot reject applications for poor health as long as application is made during the eligibility period. Large employer groups are those with 50 or more employees. Small employer groups have 2 to 50 employees.
Tips for evaluating your health insurance options
The U.S. government's official web portal USA.gov (tulsaworld.com/USA.gov) says, "Picking a health insurance plan that provides the coverage you and your family need can seem overwhelming. There are a lot of options, and it can be hard to narrow down your choices to find a plan that offers comprehensive coverage and still fits your budget. USA.gov suggests you ask these questions as you're evaluating plans:
Specialists: Are specialists such as eye doctors and dentists covered?
Special conditions: Does the plan cover special conditions or treatments such as pregnancy, psychiatric care and physical therapy?
Home or nursing home care: Does the plan cover home care or nursing home care?
Medications: Will the plan cover all medications my physician might prescribe?
Deductibles and co-pays: What are the deductibles? Are there any co-payments?
Out of pocket expenses: How much must I pay out of my own pocket to cover expenses?
Billing disputes: If there is a dispute about a bill or service, how is it handled? In some plans, you may be required to have a third-party decide how to settle the problem.
COBRA: It's not the deadly snake, but it is frightfully expensive. There was a time when employer-provided group health coverage was lost when an employee was fired, changed jobs or got divorced from the spouse whose employer provided the coverage. That ended in 1986 when the Congress passed the health benefits extension law named Consolidated Omnibus Budget Reconciliation Act (COBRA). Read "An Employee's Guide to Health Benefits Under COBRA" at tulsaworld.com/COBRA to understand your rights under COBRA.
Under its provisions, many employees and their families who would lose their group health coverage due to serious life events are able to pay to have it continued under the employer's group health plan for a limited time. If you're currently between jobs, there are health care options for you, too. You have the option of extending your previous employer's plan through COBRA. If you choose to do this, you may have to pay a higher premium amount, but you will have the same benefits previously available.
Original Print Headline: SB 1621 offers small businesses option
Tulsa World consumer writer Phil Mulkins wants to know which topics interest you. Call 918-699-8888, email your suggestion to firstname.lastname@example.org or mail it to Tulsa World Consumer, PO Box 1770, Tulsa, OK 74102-1770.
Gov. Mary Fallin talks over the Supreme Court health-care ruling with members of her staff before meeting with the press at the state Capitol in Oklahoma City on June 28. The Supreme Court upheld the individual insurance requirement at the heart of President Barack Obama's historic health-care overhaul. PAUL B. SOUTHERLAND / The Oklahoman file
When selecting a health insurance plan evaluate the options, including prescription coverage. SARAH PHIPPS / The Oklahoman file