Total Care Option (TCO)

Save up to the ACA maximum ($10,600 per individual and $21,200 per family) on your healthcare costs!

Through the TCO, Boss Energy Solutions will reimburse up to the ACA maximum ($10,600/single and $21,200/family) if you enroll in your spouse’s health insurance plan with their employer.

What does the TCO cover?

Boss Energy Solutions will cover up to the ACA maximum of out-of-pocket medical costs (copays, coinsurance, and deductibles) for your entire family. That could mean $0 for prescriptions, doctor visits, and any medical care you and your family need.

Is there a cost to enroll?

The TCO is free for you and your eligible family members to join. There is no payroll contribution required to participate. You can also continue to enroll in other Boss Energy Solutions benefits.

How do I enroll in the TCO?

During Open Enrollment, you can choose for yourself and/or any covered family members to leave the Boss Energy Solutions health plan and instead enroll in the TCO, while simultaneously joining your spouse’s employer medical plan. Those enrolled in the TCO will then have their out-of-pocket medical expenses covered!

How do I use the TCO once I enroll?

1. Present your insurance card from your spouse’s health plan to the provider or pharmacy.

2. Once you receive the EOB, doctor’s bill, or pharmacy receipt, upload it to Healia’s online portal.

3. Our partners at Healia will review the claim and reimburse you for the expense!

Are there any restrictions?

To enroll in the TCO, you or your family members must currently be enrolled in a Boss Energy Solutions health plan and then choose to leave that plan and enroll in your spouse’s employer health plan. Employees who have already waived Boss Energy health coverage are not eligible to enroll in the TCO.

Have a question? Email our partners at Healia at support@healiahealth.com.

Can I enroll in my spouse’s Medicare or ACA plan?

No, you must enroll in a group health plan sponsored by your spouse’s employer. Medicare, Medicaid, Tricare coverage, or a plan on the ACA marketplace are not eligible. Your spouse may also not be enrolled in a Boss Energy plan themselves.

Can I enroll in the TCO and a High Deductible Health Plan (HDHP)?

Yes, you are eligible to enroll in an HDHP as long as you those covered by the TCO do not contribute to a Health Savings Account (HSA) or receive employer contributions to an HSA. The HSA and the TCO are both pre-tax programs, so the IRS does not allow you to be enrolled in both at the same time. Note: if you have an HSA from a previous plan year, you can still keep it!

What happens if my spouse’s plan does not include my current doctor or a procedure?

The TCO can only reimburse you for procedures, services, and prescriptions that your spouse’s plan covers. Please check network access on your spouse’s plan and the prescription formulary to ensure coverage.

What if I lose access to coverage on my spouse’s plan?

Loss of coverage is known as a “Qualifying Life Event.” As long as you let Boss Energy Solutions know within the correct notification window, you and your eligible dependents may enroll in a Boss Energy Solutions plan without a lapse in coverage.

Am I eligible to enroll if I’m already on my spouse’s plan?

No. If you are already enrolled in your spouse’s medical plan, you are not eligible to enroll in the TCO. Current employees must first be enrolled in a Boss Energy Solutions health plan to be eligible for the TCO. Family members who are already covered under a spouse’s medical plan are also not eligible. However, new hires who have health insurance available through a spouse may choose to enroll in the TCO immediately upon hire.

How do I know whether the TCO will save me money?

Check out the Healia Savings Tool! Just upload your spouse’s benefit guide and Healia will show you how much you could save by choosing the TCO.