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2019 Southern Ohio Chamber Alliance (SOCA) Benef it Plan Producer Guide

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Table of Contents

The SOCA Benefit Plan.......................................................2

Underwriting Guidelines....................................................3

Specialty MEWA Underwriting Guidelines.....................7

Quote Process and Case Submission.............................9

Plan Offerings ................................................................... 10

SOCA Benefit Plan Renewal........................................... 11

General Administration................................................... 12

What is the SOCA Benefit Plan?The Southern Ohio Chamber Alliance (SOCA) Benefit Plan is an unique self-funded option that is offered by SOCA and administered by Anthem Blue Cross and Blue Shield. The SOCA Benefit Plan is a multiple employer welfare

arrangement (MEWA) that is backed by Anthem’s stop loss and is filed with the Ohio Department of Insurance (“ODI”).

It is governed by Trustees and by-laws that satisfy ODI requirements. It is available to small employers that have at least 2 enrolled on their medical plan, with no more than 50 total employees. These employers are required to be

members in good standing with a Chamber of Commerce that is qualified to offer the SOCA Benefit Plan. (The

qualifying chambers are listed on page 3.) This alternative self-funded solution can be a good fit for your small group

clients for many reasons including:

£ Competitive rates

£ 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

This SOCA Benefit Plan Producer Guide covers many of the important details that you need to know when discussing

this alternative with your small group clients. It will answer many of your questions regarding underwriting, quoting,

plan offerings, and administrative guidelines.

In the event of a discrepancy between this guide and any contract issued as it relates to this arrangement, the terms

of the contract prevail. The regulations in this guide are subject to change from time to time without prior notice.

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Medicare............................................................................. 14

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Underwriting Guidelines

Who is eligible? The SOCA Benefit Plan uses the following underwriting regulations in order to determine employer and employee eligibility

for benefits. These requirements are effective with the participating employer's effective date. It is very important that you

read this guide and that you understand that if the following participation requirements are not met, the participating

employer can be cancelled by the SOCA Benefit Plan as outlined in the Participation Agreement.

Eligible Employers

An eligible employer is defined as a business (or other legal entity) that is actively engaged in a full-time enterprise that

has the legal capacity to sponsor a group health plan on behalf of one or more common law employees whereby an

employer and employee relationship exists.

The employer must be a corp., LLC, partnership, or proprietorship that is actively engaged in business in the

state of Ohio. An employer-employee relationship exists. Must be permanent in nature. Includes governmental subdivisions, educational, non-profit organizations, or religious institutions. Must employ on average no more than 50 total employees on business days during the preceding calendar year

and must have at least 2 enrolled employees on the first day of the plan year. The employer will not be written or

renewed if it fails either of these tests. The employer must be domiciled in Ohio with a corporate headquarters or an entity, with the ability to enter a

contract in the state of Ohio. Eligible employers must maintain a minimum of 2 enrolled employees located in Ohio. The employer must be current with SOCA Benefit Plan product dues. Please see the SOCA Benefit Plan

Participating Business Acknowledgment for additional details.

Employers that are members of one of the following associations/chambers are eligible to participate in the SOCA Benefit Plan: Southern Ohio Chamber Alliance (SOCA), Northern Ohio Area Chambers of Commerce (NOACC), Central Ohio Chambers

of Commerce (COCC), Dayton Area Chamber of Commerce (DACC), and Youngstown/Warren Regional Chamber (YWRC).

For participating employers located in Montgomery County, the following also applies: If, at the time the employer first offers the Plan to its employees, the employer belongs only to a Chamber of

Commerce that is a SOCA member, the employer must remain a member in good standing with a Chamber of Commerce that is a member of SOCA to continue to sponsor the Plan.If, at the time the employer first offers the Plan to its employees, the employer belongs only to the DACC, the employer must remain a member in good standing with DACC to continue to sponsor the Plan.If, at the time the employer first offers the Plan to its employees, the employer belongs to the DACC and a Chamber of Commerce that is a SOCA member, the employer must remain a member in good standing with both to continue to sponsor the Plan.If, at the time the employer first offers the Plan to its employees, the employer does not belong to the DACC or any Chamber of Commerce that is a SOCA member, the employer must become and remain a member in good standing with DACC and at least one Chamber of Commerce that is a member of SOCA to sponsor the Plan.

Eligible Employees

Employees working 30 or more hours per week and who are past their probationary period (employer selected waitingperiod options are 0, 30, 60, or 90 days or the first billing after 0, 30, or 60 days worked, not to exceed 90 days) areconsidered as Eligible Employees. Eligible Employees must: Complete and submit all required applications within 30 days of the date they are eligible for benefits, or within

30 days after the waiting period has been met Be full-time employees working at least 30 hours per week and are paid by a W-2 or full-time owners/partners Social Security numbers are required

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Be reported on standard state and federal payroll reporting forms, or in the case of owners a Schedule K1 or

Schedule C. Be actively at work on effective date of benefits

Eligible Dependents

The Employee's spouse as recognized under the laws of the state where the Employee lives The Employee's or the Employee's spouse’s children, including natural children, stepchildren, newborn and

legally adopted children and children whom the Employer has determined are covered under a “Qualified

Medical Child Support Order” as defined by ERISA or any applicable law Children of whom the Employee or the Employee's spouse is a legal guardian or as otherwise required by law All enrolled eligible children will continue to be covered until the age limit of age 26 which is listed in the

Schedule of Benefits, or who is beyond the age of 26 and submitted proof of disability

Ineligible Employees

The following types of employees are considered to be ineligible from consideration as eligible employees for

purposes of health benefits:

Employees that work fewer than 30 hours per week Temporary employees who have not worked over one year Seasonal employees who work fewer than 9 months out of the year Employees absent from work and off payroll due to non-medical reasons and former employees not covered

under state or federal continuation programs 1099 Contractors except those who meet the criteria outlined below Domestic Partners Retirees Late Enrollees

1099 Contractors

Person’s whose compensation is reported on Form 1099, rather than Form W-2, may be covered if ALL the

following criteria are met:

The contractor works at least the minimum 30 hours per week to be considered full-time The employer’s contribution toward the contractor’s premium is equal to that for eligible employees The employer makes benefits available to all current and future contractors meeting the same criteria 1099 contractors work exclusively for the company they are applying through, at least 50% of the employer

is paid by W-2, and a minimum of two taxed employees are enrolled

Late Enrollees

A late enrollee is someone that applies for benefits more than 30 days after they are eligible for benefits, or more

than 30 days after the end of the waiting period. An enrollee is not late if, at the time of enrollment, the enrollee

applies within 31 days of a HIPAA special enrollment event.

Segmenting

An employer may not segment its employees into classes for determining benefit eligibility. Union plans are a valid

segment exception to the no segmenting rule.

The Health Insurance Portability and Accountability Act (HIPAA) states that all persons treated as a single employer

under subsection (b), (c), (m), or (o) of section 414 of the Internal Revenue Code shall be considered one employer.

Common Ownership

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Underwriting Rules

Minimum Participation

At least 75% of the Net Eligible Employees and a minimum of two employees must be covered under the

Participation Agreement. In determining a participating employer's minimum enrollment for Net Eligible

Employees, SOCA Benefit Plan will exclude any employee who waives benefits (“Qualified Waivers”)

because they are:

Covered by a spouse’s employer-sponsored health plan Covered under a parent’s plan to age 26 or who is beyond the age of 26 and submitted proof of disability Covered by Medicare and/or a Medicaid Non-Group Medicare Supplement Retirees In a government-sponsored plan/State low income plan, such as TRICARE, Medicaid or Veteran’s Administration

(VA), Federal Employee Program, Railroad Enrolled in an individual plan that was purchased on-or off-exchange Coverage through a prior employer's retiree plan Coverage through a second active employer A member of any recognized religion that opposes Health Insurance

Minimum Contribution Rates

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. Flat Contribution amounts are not allowed. If the employer contributes 100% of the premium

equivalent, 100% of the net eligible employees must enroll.

The SOCA Benefit Plan recommends employers establish fixed contribution rates for single and family rates in

order to avoid discrimination.

Multiple Product Offerings

A participating employer of 2-4 enrolled may only offer one plan design. A participating employer of 5-50 enrolled may offer two plan designs. A participating employer of 10-50 enrolled may offer up to three plan designs. There must be a minimum of 1 employee enrolled in each plan offered. This can be any combination of Blue Access PPO, Blue Access Options PPO (3-tiered network) and/or HSA plans.

Waiting Periods

Waiting period options are 0, 30, 60, or 90 days, or the first billing after 0, 30, or 60 days worked.

A participating employer may change their waiting period one time per year upon written request. The earliest

effective date of the change is the date of receipt of the request by Anthem, or the service date following receipt

of the request by Anthem.

The waiting period change will not impact existing employees, but rather, only new employees hired after the

request becomes effective.

Effective Dates

The earliest possible effective date is the date all new case requirements are received by Anthem’s Underwriting

department. A future effective date cannot exceed 120 days from the date the applications are signed or 60 days

from the date the employer's paperwork is submitted. Effective dates will be the 1st of the month. It is

recommended that the employer maintain current benefits until underwriting approval is finalized.

Medical Underwriting

Enrollment applications must be completed and signed by all eligible employees, including those waiving

benefits, those on COBRA or in their COBRA election period, employees not actively at work due to medical

conditions, and those in their waiting period. Full medical information is required for applicants applying for

health benefits. We do not require medical information for waivers unless fewer than 50% of the total eligible

employees are enrolling. Completion of the medical information section provides answers to health questions

about employees and their dependents. This information is used to calculate the premium equivalent rate for the

employer based on the risk of future health expenses. Each health condition has varying degrees of associated

risk. Exact information is needed regarding member diagnosis, dates, treatments, medications and prognosis to

assign an appropriate premium equivalent rate for the risk. It is important that the applicant disclose this

information with full details to ensure there is no delay in the process and that the appropriate rating is assigned.

Misstatements or failures to report medical information prior to the effective date may result in a material change

to benefits or premium equivalent rate.

The Plan retains the right to reconsider the pricing of this proposal if the final enrollment is different from what

was assumed in development of the rates.

Final rates will be based on the actual effective date. Final rates will be based on the actual location, enrolled

census, and final benefits selected.

Final approval of proposed rates is subject to review of employee applications and medical conditions for all

enrolling in the plan.

Proposed rates can be modified due to changes in the census and/or medical risk profile contained in final

applications.

Medical Open Enrollment

After initial enrollment, employees can make changes to benefit elections at open enrollment. Coverage will be

effective on the renewal date if the application is received by Anthem within 31 days prior to the group's renewal

date or up to 31 days after the group's renewal date. Applications received for existing employees outside of this

period will be late enrollees, and must wait until the next open enrollment period unless they qualify for a HIPAA

special enrollment.

Open enrollment periods apply on the original effective date and May of every year, regardless of when originally

effective.

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Specialty MEWA Underwriting Guidelines

All MEWA Specialty products will renew May 1st on even years (example: 5/1/2020, 5/1/2022, etc). Dual Options are not available.

MEWA Dental

£ Participation Requirements: Minimum of 60% of net eligible employees must enroll in this plan. If

50% or more of the employees are located outside the employer's state of domicile, acceptance is

contingent upon underwriting approval. Dental offices are not eligible for coverage.

£ There are no contribution requirements for dental

£ Option B available for groups with 5 or more enrolled

£ No waiting periods

£ Annual Open Enrollment – follows medical guidelines £ Rates are based on information received by Anthem. If at the time of enrollment

there is a significant change in any of the information, Anthem reserves the right to withdraw or

modify the quoted rates.

£ 10.00% broker commission is included. £ This Anthem plan assumes no underlying funding of any type including, but not limited to, copays,

deductibles and other cost-shares.

£ Ancillary products are only available when paired with a SOCA MEWA medical product.

Termination of all active ancillary products will apply when the SOCA MEWA medical product is

terminated.

£ Final rates are subject to underwriting approval and verification of all assumptions used in the

proposal rating.

MEWA Vision

£ Employer Paid

• Participation – Vision must be sold alongside Medical: Minimum of 2 enrolled employees and at

least 50% of total eligible employees.

• Contribution – Minimum 50% employer contribution of the individual tier premium rate.

£ Voluntary

• Contribution – Less than 50% employer contribution of the Individual tier premium rate

£ Annual Open Enrollment – follows medical guidelines

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MEWA Life

£ Life insurance is guaranteed. Coverage is not guaranteed for late enrollees. Timely enrollmentrequired for new employees. Employees hired after the effective date of the plan will become eligible

for insurance after completing the waiting period specified in the policy. Eligible employees must be

enrolled within 31 days after they satisfy the employer’s eligibility period, or they will be required to

submit Evidence of Insurability for Underwriting approval

£ Waiver of premium – if an employee becomes totally disabled before reaching age 60, after they meet

a six month elimination period, their life insurance coverage will remain in force without further

premium payment until they reach age 65. Life insurance coverage continued under waiver of

premium terminates at age 65.

£ Living benefit/accelerated death benefit – employees can receive an accelerated payout of up to 75% of their life insurance benefit if they are diagnosed as terminally ill.

£ AD&D coverage – includes Seat Belt Benefit, Airbag Benefit, Education Benefit, Repatriation Benefit,Coma Benefit, and Common Carrier Benefit.

£ Basic Life: Employer pays 100% of premium. 100% of eligible employees must participate. £ Optional Supplemental Life Insurance: 100% employee paid. Greater of 20% of eligible employees or

six employees must enroll.

£ Life and AD&D benefits reduce due to age as follows: 35% at age 65; 50% at age 70.

£ All benefits terminate at retirement.

£ Timely enrollment is required for new employees. Employees hired after the effective date of the plan

will become eligible after they satisfy employer’s eligibility period, or they will be required to submit Evidence of Insurability for Underwriting review.

£ Workers whose wages are reported on Form 1099 are not eligible for coverage.

£ Groups must be in business for at least one year.

£ The master policy will be issued and will reflect the laws and requirements of OH.

MEWA Disability

Short Term Disability

£ All coverage is guaranteed issue for groups 6-50. Groups 2-5 must submit Evidence of Insurability for

Maximum Weekly Benefit over $500.

£ STD is contributory. Employer must contribution 50% of premium.

£ 75% of eligible employees must enroll.

£ Partial Disability is included.

£ Work Retention Benefit is included.

Long Term Disability

£ Coverage is guaranteed issue for groups 6-50. Groups 2-5 must submit Evidence of Insurability for

Maximum Weekly Benefit over $500.

£ LTD is contributory. Employer must contribution 50% of premium.

£ 75% of eligible employees must enroll.

£ Two Year Own Occupation disability definition.

£ 3/12 Pre-Existing Condition Limitation applies.

£ There is a 24 month limitation for Mental Illness, Drug Addiction or Alcoholism per lifetime.

£ Special Conditions limitation applies.

£ Family Social Security Integration applies.

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Quote Process and Case SubmissionFormFireThe SOCA Benefit Plan will utilize the FormFire platform for the following purposes:

£ Gather member data £ Obtain employer information £ Request an underwritten quote

£ Submit sold case paperwork

£ Source of employee eligibility and enrollment information £ Other compliance items£ Submit renewal benefit change paperwork£ Submit open enrollment, new hire, and member maintenance change applications to Anthem£ Verify employer participation

For brokers already using FormFire services, nothing will change, and you will gain access to the SOCA Benefit Plan platform automatically once certified.

Brokers not currently using FormFire should submit a request to https://www.formfire.com/public/billing/agency-setup. FormFire will contact and train the new broker to use the site correctly.

Quote ProcessQuote requests should be sent to OHSGUWPrescreens@anthem.com to obtain a prescreened rating factor via FormFire. Prescreen turnaround time is approximately 3-5 business days. Brokers will generate all quotes via the eQuote tool using the prescreened medical factor underwriting supplies.

Materials needed to obtain a prescreened quote for a new client include:£ Employer questionnaire completed in full£ Medical questionnaires (Medical information on waivers is not required unless fewer than 50% of total

£

£

eligible employees are enrolling)Census generated via FormFireIf a group is currently ASO, claims experience, large claimant listing, breakdown of fee/claim components, and fully insured equivalent rates are also needed.

Sold Case Submission ProcessThe sold case submission process will also be handled via the FormFire platform and then submitted to Anthem. Please allow a minimum of 15 days for processing a new case submission.

Materials needed in order to submit a sold SOCA Benefit Plan case for enrollment are as follows:

1. SOCA Benefit Plan Participation Agreement – submitted to the SOCA Benefit Plan via info@joinsoca.com2. SOCA Benefit Plan Participating Business Acknowledgment Agreement – submitted via info@joinsoca.com

3. SOCA Benefit Plan employer application4. Signed rates, benefits and quote stipulations5. SOCA Benefit Plan employee applications – will be loaded into FormFire and submitted via Anthem Excel

template/IM01 file6. Proof of membership in a Chamber of Commerce that is qualified to offer the SOCA Benefit Plan –

submitted to Anthem via FormFire and to the SOCA Benefit Plan via info@joinsoca.comAcceptable proofs are: £ A letter from the Chamber of Commerce stating that the employer is a member in good standing.

The letter must be on letterhead that is specific to the employer’s declared Chamber of Commerce. £ An email from the employer’s declared Chamber of Commerce stating that the employer is a

member in good standing. The email must specify the sender’s name and title, and must also show the sender’s email address, date, and time stamp. It is acceptable for the broker to obtain this email from the Chamber of Commerce on behalf of the client and to forward it to SOCA.

£ A copy of a cancelled check or credit card receipt that indicates payment of Chamber membership dues.

7. Electronic Funds Transfer (EFT) banking form and voided check (Initial premium will be withdrawn via EFT).8. Most recent Quarterly Wage & Tax Statement

Eligible documentation in lieu of a Quarterly Wage & Tax Statement: Sole Proprietor Schedule C Partner of Partnership Form 1065 with Schedule K-1 Owner of C corp Form 1120 Owner of S Corp Form 1120S with Schedule K-1 Church Group Form W-3 and W-2 or payroll register

Prior Carrier DeductibleDeductible credit is available to new cases. This is available only to participating employers with previous calendar year benefits. Please work with your sales executive to submit the proper documents.

£

£

£

£

£

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Plan O�erings

Medical Offerings

The SOCA Benefit Plan offers various PPO and HSA options. These options either utilize our Blue Access PPO

network or our Blue Access Options PPO network (3-tiered network).

Ancillary Offerings

As a member of the SOCA Benefit Plan medical arrangement participating employers are eligible for discounted

ancillary plan offerings. Anthem offers a variety of Dental, Vision, Life and Disability options as part of the SOCA

Benefit Plan portfolio. These are stand-alone, fully insured plans for which the participating employer contracts

directly with Anthem. Because of this, enrollment, ID cards and billing will be separate from the medical plan

offering. The ancillary offerings will have a common renewal date of May 1 in order to align with the medical

offerings. Anthem will offer several dental, vision, and basic and optional life plans all at a special

shelf-rated premium. Pre-developed plan and rate highlight sheets are included with all medical quotes. Anthem

will also offer both long-term and short-term disability options that are underwritten and can be requested from

your Sales Executive.

Ancilary Sold Case Submission Process

The sold case submission process for ancillary will also be handled via the FormFire platform and then submitted

to Anthem. Materials needed in order to submit a sold case for enrollment are as follows:

Dental Sold Case Submission

£ Dental master employer application

£ Dental enrollment template (IM01)

£ Signed rates and benefits

£ Dental customer checklist

£ Proof of chamber membership

£ Electronic Funds Transfer (EFT) banking form and voided check (optional)

Vision Sold Case Submission

£ Vision enrollment template (IM01)

£ Employer application (51+ fully Insured application)

£ Signed rates and benefits

£ Proof of chamber membership

£ Electronic Funds Transfer (EFT) banking form and voided check (optional)

Life & Disability Sold Case Submission

£ Life & Disability enrollment template (IM01)

£ Employer application (51+ fully insured application)

£ Signed rates and benefits

£ Proof of chamber membership

£ Electronic Funds Transfer (EFT) banking form and voided check (optional)

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The SOCA Benefit Plan renews on May 1 of each year.

Renewal Process

Renewals will be produced via the small group renewal process approximately 90 days prior to the renewal dateand fed through the e-Renewal system (Same system that you use today for your Grandmothered block of business).

£ All renewals are mailed directly to the employer group and will include alternate renewal options andancillary offerings.

£ Additional plan renewal options can be generated via the e-Renewal quoting tools.£ If you want to renew the plan we are offering, product and pricing updates are required in FormFire by the

broker. Then, we will take care of the rest. £ It is recommended that any plan changes be submitted two weeks prior to the renewal date in order to be

processed in time. Anthem only needs paperwork (signed rates and benefits) on cases opting to change plan designs. Plan changes will require two steps: 1. Load the signed renewal rates / benefits in FormFire2. Send the signed renewal rates/ benefits via FormFire to Anthem via ohsmallgroupreclass@anthem.com.

All open enrollment member level changes need to be made in FormFire. FormFire will send all member-level medical open enrollment changes electronically to Anthem for processing via a weekly feed. £ For dual or triple options, employee plan elections will be captured in FormFire via a spreadsheet showing

which subscribers/members should be loaded to which plan. You must send both the plan elections and signed benefits via FormFire to Anthem via ohsmallgroupreclass@anthem.com.

Off-Cycle Benefit Changes

Participating employers are allowed to make one off-cycle benefit change per year outside of the 150 day periodprior to the May 1 renewal date.

Census Reconciliation Process

All Participating Employers are required to complete the Annual Rate and Census Reconciliation Form at the end of each plan year. Participating Employers will be given a 60-day timeframe, from March 1st through April 30th, to download and complete the Census Reconciliation Form. Confirmation ensures that the Participating Employer still qualifies under the SOCA Benefit Plan Underwriting Regulations. A prefilled Census Reconciliation Form may be downloaded in FormFire by following these steps:

£ Go to Manage Documents in Client Details £ Select Add Document (upper right-hand side) £ Select Census Reconciliation Form (toward bottom of text box) £ Click Add £ Once the Form generates, open it and review the Form for accuracy £ If the Form is correct, no other action is needed. Please leave the Form in Manage Documents (document

center). FormFire will retrieve the document and send it to Anthem on the Employer’s behalf. £ If the Form is not accurate, make corrections and save a copy of the revised Form and upload it to Manage

Documents (document center). The revised Census Reconciliation Form must be saved in an Excel format. FormFire will retrieve the Form and send it to Anthem on the Employer’s behalf.

£ Use the following naming convention to save a copy of the revised Form: RevisedCensusReconciliation-MonthDayYear.xlsx (e.g., CensusReconcilaition-01012018).

A Wage & Tax Statement is not required. You may be required to provide a Wage and Tax Statement later if your group is selected by the plan auditors for additional testing. If you do provide a copy of your Wage and Tax Statement with the Annual Rate and Census Confirmation, the document will be saved in the Plan's files and you will not be required to provide the document again should your group be selected for audit testing.

Contact the FormFire Support Team at support@formfire.com with questions.

SOCA Bene�t Plan Renewal

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General Administration

BillingAnthem will bill the participating employer a premium equivalent rate on behalf of the SOCA Benefit Plan. EFT will be the

required method of payment. Anthem will initiate the demand debit transaction on the Invoice Due Date; however, if the

Invoice Due Date falls on either a banking holiday, a Saturday or a Sunday, the withdrawal shall be made on the following

banking day.

SOCA Benefit Plan product dues will be billed to the participating employer on an annual basis by the SOCA Benefit Plan.

Dues are calculated at $4.00 Per Enrolled Employee Per Month and will be due 30 days after the participating employer's

effective date. SOCA Benefit Plan product dues are also billed annually at renewal time. Please see the SOCA Benefit Plan

Participating Business Acknowledgment for additional details.

Delinquency ProcessIf a participating employer fails to pay their premium equivalent rate by the due date, they will receive a

termination/reinstatement letter. The participating employer will have 15 days to apply for reinstatement via

the process outlined in the letter.

Group TerminationsGroup termination letters must be on letterhead from the participating employer and submitted to the Sales Executive

for processing 30 days prior to the requested date for terminations at renewal time and 60 days prior to the requested

date off-cycle.

New Hires & Member/Dependent Status ChangesEligible employees (and their dependents) working 30 hours or more may apply for benefits as a new hire. Applications

must be submitted for processing to Anthem within 31 days of the employee’s eligibility date. Special enrollment event

applications should be submitted within 31 days of the qualifying event date. Late enrollees will be denied, and the

member can elect benefits at the participating employer's next open enrollment period. Special Event qualifications are:

marriage, birth or adoption of a child, or loss of coverage.

An employee can request to terminate a dependent from benefits at any time. An employee’s benefits will terminate when

any of the following occurs: termination of employment, retirement, employee requests plan termination, or a reduction of hours below the 30 hour minimum. Benefits will terminate at the end of the month in which the status change occurs.

Please visit the FormFire site for additional information on the EDI File Transmission details.

Cobra & State ContinuationCOBRA and State Continuation under the SOCA Benefit Plan follow the Federal and Ohio laws. Under Ohio law, for groups

up to 50 eligible employees, an employee may have a right to continue health benefits upon termination of employment if

the employee has been continuously enrolled under a group policy during the entire three months preceding termination

of employment and meets certain other Ohio law requirements. See O.R.C. Section 3923.38 for more information.

For groups with 20 or more employees for at least half of the previous calendar year, Federal COBRA law allows for

continuation coverage under certain situations. Under COBRA, the employer is responsible for administration. The law

requires a timely application and payment of premium for COBRA benefits to continue.

The SOCA Benefit Plan has selected a COBRA vendor for all groups participating in the SOCA Benefit Plan.

MyCOBRA Plan is the exclusive continuation provider for Participating Employers in the Anthem SOCA Benefit Plan.

Employers must use MyCOBRA Plan, so that continuation can be administered for SOCA participants. MyCOBRA Plan will

administer federal and state continuation services for employees enrolled in the Anthem SOCA BP, including: general

notice distribution, qualifying event administration, premium billing and collection and COBRA termination processing.

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Regulatory ComplianceParticipating employers who offer ERISA-governed employee benefit plans must comply with regulatory

requirements for plan sponsors. The SOCA Benefit Plan provides assistance in meeting these compliance

obligations by offering an ERISA compliance service. Participating employers should exercise care in

meeting these compliance obligations. Please refer to the participation agreement for further details in

addition to seeking legal guidance from your attorney.

Broker Distribution

Select brokers are eligible to sell the SOCA Benefit Plan after the required training has been completed. Brokers must also be a member of a qualifying chamber in order to be eligible to sell the SOCA Benefit Plan.

General Administration (continued)

Commission Information

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Medicare

In order for Medicare Primary Payor rules to apply under the SOCA Benefit Plan for participating employers with fewer

than 20 employees (on each working day in 20 or more calendar weeks in the current or preceding calendar year),

participating employers must request and be approved for Small Employer Exception to the Medicare Secondary

Payor rules.

Who Qualifies

To qualify for this exemption Employers and their Medicare Aged Employees must meet two criteria. Some additional

criteria apply to specific circumstances.

Employees and/or dependents must be entitled to Medicare on the basis of age and still enrolled in

their SOCA Benefit Plan Participating Employer’s group health plan.

Participating Employers must employ fewer than 20 total employees (both full and part time) for the

preceding 20 calendar weeks and must continue to employ fewer than 20 total employees for the entire

time the exception is allowed.

How does the process start?

The SOCA Benefit Plan identifies possible candidates for this exception request based on age and group size and will

notify the broker associated with that group by e-mail. The notification contains further instructions on how a

participating employer can request the exemption. Read all instructions fully. If the identified Medicare Aged

Participant is not going to be enrolled on the group health plan or the Participating Employer does not meet the

criteria above, no registration needs to be completed.

FAQ

Q: Can I request an exemption in anticipation of turning 65 or if the SOCA Benefit Plan has not sent an invitation

to request an exemption?

A: No, only candidates identified by the SOCA Benefit Plan may request an exemption. Exemption requests

require initiation by the SOCA Benefit Plan.

Q: I believe my group is eligible for an exemption but I have not received a notification e-mail. What can I do to

ensure I have the opportunity to register?

A: Ensure all information contained on the Formfire platform is up-to-date. Broker e-mails, group size, and

enrollment information must be current for the notification process to correctly identify candidates.

Q: Who can I contact with questions about Medicare?

A: The SOCA Benefit Plan does not provide a resource for questions concerning Medicare. The Center for Medicare

Services has a variety of contact numbers available on their website for different topics concerning Medicare.

For further information, brokers and Participating Employers can consult www.cms.gov.

Medicare

Anthem Blue Cross and Blue Shield is the trade name of Community Insurance Company. Independent licensee of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc.

OHSOCABPPG 10/18