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Opt Out Benefit Surprise For Oklahoma and Texas From ACA


Opt Out Benefit Suprise – May Be Subject to ACA

The Texas and Oklahoma systems get an Opt Out benefit surprise. Oklahoma and Texas will be the two states with opt out provision in their Workers Comp Laws.   One of the areas of concern with the upcoming passage of the opt out provisions is that all benefits will be subject to Obamacare in 2014.

Picture Of Employee Opt Out Benefit Group
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Section 2715 of Obamacare is known as the SPD section.  All benefits that are provided to employees by their employer must be in the SPD (Summary Plan Description).  As Workers Comp in an opt out program is no longer actually a Workers Comp program, the benefits will be a health and disability policy administered by the employer.

This may be a development of little consequence, however, as each section of the Health Act will only be known in 2014 and forward.  Our Supreme Court says it is a tax – but regardless the SPD’s will be directly monitored and enforced -(by the IRS?)

One Texas and two Oklahoma insureds are considering the opt out programs once the bill is signed by  Oklahoma’s Governor.  All three companies did express this concern.

Hand With Magnifying Glass Opt Out Benefit Icon
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There are other areas of the Health Act that opt outs may be subject to in the future.  The companies may want to consider testing the water before “jumping into the river.”   In other words, companies in Oklahoma and Texas that decide to use the opt out method may actually be Federalizing their Workers Comp benefits.

The crystal ball on the future of opt outs may still show these types of programs as the future for Workers Compensation.  Jumping right in may prove the water to be very cold.  The opt out benefit may not be what a company expects from the ACA.

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James J Moore - Workers Comp Expert

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Management Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications


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