FAQs

What’s the advantage of going through the ODA for my health coverage?

The ODA Wellness Trust was designed to save member dentists money. It is unique and available only to ODA members and their staffs.   Because the ODA Wellness Trust is a self-insured plan, it has many benefits, including the ability to design plan and deductible options, choose networks and features, and keep costs low by avoiding the state insurance premium tax and many of the ACA’s mandated taxes. For details on how we can save you money, contact us at 800-282-1526 or insurance@oda.org.

Why offer an employer plan?

Group health plans – like the ODA Wellness Trust – purchased through a payroll deduction can be paid with pre-tax dollars. The employee gets a tax break on monthly associated costs of at least 15 percent.  By paying for health benefits with pre-tax dollars, the employee does not pay federal, state or social security taxes on the cost of his or her health benefits. This is beneficial to employees instead of paying for individual health benefits with after tax dollars, even if the employer chooses not to make any contribution to the cost of the plan. The employer saves the social security matching tax also.

What health plans are available for dentists and their staffs through the ODA?

The ODA Wellness Trust is your solution.
Ohio Dental Association member dentists can enroll in the ODA Wellness Trust to receive high quality health benefits for them and their staffs at affordable rates.

The ODA Wellness Trust is a private, dentist owned, self-funded, employer health benefit plan. It was exclusively developed by member dentists for member dentists and their staffs to help battle the increasing cost of providing health care benefits.  It offers traditional benefit plans with different deductible levels and Health Savings Account plans.  To review our plans, click here.

When can I enroll in the plan?

There are two times when you can enroll in an existing ODAWT employer plan. The ODA Wellness Trust holds an annual renewal in the fall when new offices and employees may join the Trust to be effective January 1. Annual renewal is held in October. Alternatively, if you have a qualifying event, such as loss of your current health benefits, you may enroll within 60 days of the date of the event. 

How many hours do I have to work to be eligible for the Wellness Trust?

Each dentist determines the number of hours (between 25 and 30 per week) that employees must work to qualify for their employer health plan. Please click here for Employee Definitions.

Does everyone in the office have to participate in this plan?

All eligible, full-time employees must be offered the opportunity to participate, but if they do not want to participate, they simply sign a waiver form declining to participate.

Groups must meet the minimum participation criteria for group coverage.  Participation requirements are based on the number of employees enrolled versus the number of employees eligible.  A minimum of two participants per group is required.  Please contact ODAWT with questions regarding final Participation Calculation.

How can I know if my doctor accepts this health care plan?
 
The ODA Wellness Trust has contracted with Medical Mutual of Ohio to provide access to their broad health care provider network. You can see if your preferred providers are in the network by clicking here. You should always check to make sure doctors are in-network prior to any service.

I have health benefits through my spouse's employer, so I don’t need my employer’s coverage. Can I just waive my employer’s coverage if they let me work full time?

Yes. The individual shared responsibility provision requires you to maintain coverage, but as long as you remain covered by your spouse’s policy, you’re complying with the requirement and won’t be subject to any penalty.

If you work full time and become eligible for your employer’s coverage, you can waive it and keep your existing coverage, and nobody gets penalized. Be aware, however, that some companies have started charging more to cover employees’ spouses who have access to their own employer-sponsored plans. So double check the details with your employer and your husband’s.

What is FormFire?

FormFire is an insurance carrier-accepted, ACA & HIPAA compliant, online benefits application service.  FormFire reduces the amount of effort, time, cost, and paperwork regarding the Personal Health Questionnaire the ODA Wellness Trust quote process.  Please click here for the Employee’s Guide to Using FormFire.

What if I have trouble completing the paperwork or don’t understand the plan(s) offered?

The ODASC staff is available to offer assistance and can be reached by phone at 800-282-1526 or by email at insurance@oda.org.  ODASC representatives are licensed agents with the Ohio Department of Insurance and can walk you through the various options available. They do not receive a commission on sales, so you can be assured they have your best interest at heart.

ODASC understands that your practice day is busy. Representatives will work to answer calls in the order received and return your call promptly however, we may not always be available when you are.  Please consider submitting your questions via email to insurance@oda.org as a more convenient way to receive a response without interruption.

What is a qualifying event?

A qualifying event is a life change that makes you eligible within 60 days of the event to change your health coverage outside the annual enrollment period. Life changes might include a marriage, birth, adoption, death, divorce, loss of coverage due to reduction in work hours, loss of job, relocation, or loss of student insurance or Medicaid.  It is not a voluntary loss of coverage or due to non-payment. Proof of qualifying event is required to be submitted at the time of application.  Please click here for a list of acceptable events and the required documentation.

How do I request termination of an ODAWT enrollee?

An employer wishing to remove an employee or an enrollee who no longer wishes to continue coverage needs to notify ODA Wellness Trust in writing prior to the requested termination date.  The termination request may be submitted via email to insurance@oda.org or by fax to (614) 340-9444.   Please do not submit requests directly to Medical Mutual of Ohio.  You will receive confirmation that the termination was received and is being processed.

How do I request a dependent change under ODAWT?

Changes regarding a dependent require a change application to be completed with the updated information and must coincide with a qualifying event(if adding).  A request to add a newborn as of their date of birth must be received within 30 days of the date of birth.  A plan/deductible change may only be made during annual renewal.  Please contact us at 1-800-282-1526 or by email at insurance@oda.org for further assistance.

What are the advantages of a self-insured plan?

There are several reasons why ODASC chose the self-insurance option:

  1. Allows ODA members to come together as a whole for the collective buying power normally only available to large employers.
  2. The ODA Wellness Trust was created by ODA members, for ODA members and is operated and controlled by ODA members.
  3. As a not-for-profit self-insured plan, reserves beyond those prescribed by the Ohio Department of Insurance are reinvested in the plan to maximize benefits and keep costs as low as possible.
  4. The ability to customize the plan to meet the specific health care needs of member dentists as opposed to purchasing a “one-size-fits-all” insurance policy.
  5. The ODA Wellness Trust is not subject to conflicting state health insurance regulations/benefit mandates, as self-insured health plans are also regulated under federal law (ERISA).
  6. The ODA Wellness Trust is not subject to state health insurance premium taxes, which are generally 2 to 3% of the premium's dollar value, an additional savings for members.
  7. The ODA Wellness Trust is free to contract with the providers or provider network best suited to meet the health care needs of member dentists and their employees.

What are the liabilities of a self-insured plan?

Because the ODA Wellness Trust is a self-insured plan, the benefits are not guaranteed by a licensed insurer and are not covered by the Ohio Life and Health Guaranty Association. In the event that the multiple employer self-insured health plan is unable to pay its obligations, participating employers shall be required to contribute on a joint and several basis the funds necessary to meet any unpaid obligations. To mitigate this risk, the ODA Wellness Trust purchased a stop-loss insurance policy to protect the Wellness Trust assets against losses above a certain threshold. 

Can an employer deduct the staff’s portion of the health policy from their paycheck?
 
Yes. Group health plans – like the ODA Wellness Trust – purchased through a payroll deduction can be paid with pre-tax dollars. The employee gets a tax break on the monthly associated costs of at least 15 percent.  By paying for health benefits with pre-tax dollars, the employee does not pay federal, state or social security taxes on the cost of their health benefits. This is beneficial to employees instead of paying for individual health insurance with after tax dollars even if the employer chooses not to make any contribution to the cost of the plan. The employer saves the social security matching tax too.

How will I be billed?

Payment of health care fees will be required monthly. Bills will be mailed out on or about the 15th of the month prior to the billing month and remittance will be due on the 1st of every month.

Payments can be mailed to ODA Wellness Trust, P.O. Box 932851 Cleveland, OH 44193, or monthly payments can be withdrawn automatically from your bank account. Only one electronic funds transfer can be established per office and it must be for the entire amount of the invoice. Complete the automatic withdraw form and return with a voided check to ODA Wellness Trust, 1370 Dublin Rd. Columbus, OH 43215 or fax to (614) 340-9444.

Can I use my credit card to pay the monthly invoice?

No, the Wellness Trust does not accept credit cards in order to save the members the cost that banks charge to use the cards. You are able to have your Ohio Dental Association Wellness Trust Health Plan monthly payments withdrawn automatically from your bank account. Only one electronic funds transfer can be established per office and it must be for the entire amount of the invoice. Complete the automatic withdraw form and return with a voided check to ODA Wellness Trust, 1370 Dublin Rd. Columbus, OH 43215 or fax to (614) 340-9444.

Do these plans comply with the Affordable Care Act (ACA)?

Yes. The ODA Wellness Trust covers the same set of Essential Health Benefits as mandated in the ACA with the exception of pediatric dentistry. Members who provide pediatric dental services to their family members can apply for a waiver of the pediatric dentistry requirement if they desire to do so.

The essential health benefits include:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance abuse disorder services
  • Prescription drugs
  • Laboratory services
  • Preventive and wellness services
  • Pediatric services
  • Rehabilitative and habilitative services and devices

Renewal Information

The ODA Wellness Trust is now in its fifth plan renewal, and 2020 plan renewal information is mailed to all participating offices in early October. Standard Open Enrollment dates are October 15 through November 15 for an effective date of January 1.

Why did my office receive IRS Forms 1094-B and 1095-B from the ODA Wellness Trust?

In an effort to assist employers with their Patient Protection and Affordable Care Act (PPACA) reporting responsibilities, The ODA Wellness Trust (ODAWT) provided IRS Forms regarding your health plan.  The information on the forms will assist your employees and the IRS to establish they have met their individual mandate to maintain minimum essential health coverage. Forms are mailed annually to each employer during the last week of January.

Please click here for additional information on:

  • What do I do if there is incorrect information on the Form?
  • What do I do with the IRS Form 1094-B?
  • What am I required to do with the IRS Form 1095-B?
  • What if my form does not indicate coverage for all 12 months?

How do I know if I need a group health plan or an individual plan?

If you are an employer who wants to offer a health plan to your office, you probably need a group health plan. More and more employers who are being asked by their employees for help in meeting the health coverage mandate are establishing tax-advantaged employer plans. If you need clarification, please contact us at 800-282-1526 or insurance@oda.org during Annual Open Enrollment Period or when you are establishing a new office.

If you are an employee at an office that does not offer health coverage, you probably need an individual health plan. The Affordable Care Act includes a mandate for most individuals to have health insurance or potentially pay a penalty for noncompliance.

For more information on deciding if individual health insurance is right for you, click here.

What are the laws/rules concerning keeping adult children (over the age of 21) on a family policy?

If a plan covers children, they generally can be added to or kept on a parent's health policy until they turn 26 years old.  Adult children can join or remain on a parent's plan even if they are:

  • Married
  • Not living with their parents
  • Attending school
  • Not claimed as a dependent on their parent’s tax return
  • Eligible to enroll in their employer’s plan

*These rules apply to both job-based plans and individual plans bought in or out of the Marketplace

When an adult child reaches the plan’s age maximum, what happens?

The adult child who is reaching the maximum age limit will lose coverage at the end of his or her birthday month.

Loss of existing coverage because of age triggers a special open enrollment period.  The open enrollment window begins 60 days before the coverage ends and continues for 60 days after it ends. The applicant will receive proof of coverage loss from his or her current carrier and should begin applying for new coverage at the start of the open enrollment period.  Remember that enrolling during the 60 days after the existing policy ends will result in a gap in coverage.

What is a Health Savings Account (HSA)?

Health Savings Accounts (HSAs) are a tax-advantaged medical savings account tied to a high-deductible health plan. Funds contributed to an HSA account are not subject to federal income tax at the time of deposit.  HSA funds can be used to pay your deductible as well as to help pay for services not covered by your health plan. Unlike a flexible spending account (FSA), HSA funds roll over and accumulate year to year if not spent. 
After retirement, any existing HSA funds can be used for medical and long-term care expenses.

Helpful Tips

ODASC understands that your practice day is busy. Representatives work to answer calls in the order received and to return calls promptly. However, we may not always be available when you are.  Please consider submitting your questions via email to insurance@oda.org as a more convenient way to receive a response without interruption.

An email is generated to confirm receipt of all faxes submitted to ODAWT at (614) 340-9444 within one business day.  Please include with your fax an email address where the fax receipt confirmation should be sent.   If you do not receive a confirmation of fax receipt (please check your junk/spam file), the ODAWT has not received your fax.




Questions?

We can answer any questions you may have about your health benefits. Contact us today, we're here to help!