This document will be reviewed and discussed at the May meeting.  Please bring a printed copy with you and make any suggestions either using this forum or by email to ben and I.

John

 

AMENDED AND RESTATED
POLICIES & PROCEDURES OF
ONE CALLS OF AMERICA
Insurance Committee

VEBA TRUST

1. The VEBA Trust Account shall reimburse the General Account for administrative costs on a quarterly basis.

2. The VEBA Trust Account is used for all insurance programs; premium payments, prescription and medical reimbursements, disability checks, etc. Checks on these accounts can be signed by signatories approved by the Board. The Assistant Treasurer is authorized by the Board to manage the excess revenue from the VEBA Trust Account to secure a higher yield.

3. Members of the VEBA Trust plan program not participating in the ACH program will provide a deposit in the amount of their average month’s bill to be used for prompt payment. This amount will be calculated by OCOA. These funds will not be considered payment of a bill if it becomes necessary to use these funds. Any bill will be considered unpaid until the deposit funds are replaced.

PSF VEBA TRUST
1. The PSF VEBA Trust Account shall reimburse the General Account for administrative costs on a quarterly basis.

2. The PSF VEBA Trust Account is used for major medical insurance programs; premium payments, prescription and medical reimbursements. Checks on these accounts can be signed by signatories approved by the Board. The Assistant Treasurer is authorized by the Board to manage the excess revenue from the PSF VEBA Trust Account to secure a higher yield.

3. Members of the PSF VEBA Trust plan program not participating in the ACH program will provide a deposit in the amount of their average month’s bill to be used for prompt payment. This amount will be calculated by OCOA. These funds will not be considered payment of a bill if it becomes necessary to use these funds. Any bill will be considered unpaid until the deposit funds are replaced.

INSURANCE COMMITTEE

1. VEBA Trust and PSF VEBA Trust Net Assets Retention Policy

This policy is to set limits of retained net assets of the VEBA Trust and PSF VEBA Trust how any excess is to be dispersed to the participating members of the programs within the Insurance Committee, and how any shortages will be dealt with.

Retained net assets are divided into three parts:

PART 1 – The minimum retained net assets in the VEBA Trust and PSF VEBA Trust is to be equal to twice the member with the largest monthly premium total. This amount is to be used only if a member cannot or will not honor its monthly billing from OCOA. This is to act as a safeguard to protect OCOA from any possible complications concerning payment of premiums from the VEBA Trust and PSF VEBA Trust.

PART 2 – On an annual basis a report is to be produced, by the person responsible for the accounting services of the VEBA Trust and the PSF VEBA Trust for the percent allocation of excess funds for each center through the end of the prior year based on the contribution in the individual plans. The report is to be presented to the members of the Insurance Committee during the fall meeting of the membership.

PART 3 – VEBA Trust and PSF VEBA Trust shall retain six percent (6%) of the previous year’s premiums.

Insurance Committee members will receive premium reduction, in the form of a check to the center, in accordance with the percentage of their premiums paid during the previous year, to the total of all premiums paid in for the period under consideration.

Members will only be eligible for any specific returned premiums if they have paid into that particular carrier. (Example – If the major medical carrier returns premiums, only the members paying into the major medical carrier will be eligible for a percentage of the returned premiums equal to the percentage of the major medical premium total they paid in.)

2. Insurance plan participants are to pay one (1) month’s prepayment if the center is in the Insurance program but is not participating in the ACH withdrawals. (Adopted 1/22/2002)

3. Insurance plan participants terminated from the plan before the end of the plan year will be responsible for any shortfall applicable to their center as of the termination date. Participants will also relinquish any positive balance remaining as of the termination date. (Adopted 4/27/2002)

4. When a short-term disability member exhausts their benefit period and/or has applied for or been accepted for long term disability benefits the employee is no longer covered by other insurance programs affiliated with OCOA.

5. The Partially Self-Funded Insurance Program has a stop loss as noted on the attachment.

6. Voting on motions brought before the Insurance Committee will be limited to the centers participating in that particular program with one vote per center. All members may vote to institute a new program.

7. If a member leaves an Insurance Program, that member may not return to that program or other program for similar service for a period of two calendar years, unless agreed to by a vote of the group participating in that program.

8. Members have ninety (90) days from the date of service, listed on the EOB, to make a request for eligible reimbursement for services. Members have sixty (60) days from date of prescription to make a request for reimbursement for prescription.

9. Investment of VEBA Trust and PSF VEBA Trust funds – The investments, of the retained earnings of the VEBA Trust and the PSF VEBA Trust are to be FDIC insured accounts within the limits set by the FDIC to be fully insured. The investments are to be liquid in nature so to allow access if needed to make payments.

Date Last Reviewed: _______________________