| About AllPharm Employee Benefits |
Q: What is the AllPharm Employee Benefits healthcare plan?
A:
AllPharm Employee Benefits is a new employee healthcare program designed exclusively for member employers. It is a fully insured employee benefit plan that meets all federal standards including ERISA and HIPPA. Some of the major plan features include:
• Comprehensive medical and prescription drug coverage
• Benefits are fully guaranteed by qualified “A” rated insurers
• Easy access to local, regional and national PPO networks like PHCS (www.phcs.com) and Beechstreet (www.beechstreet.com)
• Additional coverage is available for vision, dental, group life, and short-term disability
• Up to $1 million per covered person per year
• All benefits are fully guaranteed to the 1st eligible dollar
• Plan deductibles starting at $250
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Q: Is AllPharm Employee Benefits categorized as insurance?
A:
AllPharm Employee Benefits is not in and of itself insurance. The plan however, purchases insurance direct from the world insurance market under one policy guaranteeing all of the eligible medical benefits from the first eligible dollar to the limits set forth in the Summary Plan Description. The benefits under AllPharm Employee Benefits are guaranteed in full from the first eligible dollar to the limits of the plan by qualified “A” rated underwriters at Lloyd’s London.
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Q: Will AllPharm Employee Benefits save my company money?
A:
Each employer may select and provide the benefit plan that fits their pocketbook and all other things being equal, the cost of providing benefits under the new Plan has been reduced by 10% to 15% and in some cases as much as 20% or more when compared with other available commercially insured group benefit plans.
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Q: I have looked at a variety of healthcare programs for my employees and nobody has been able to deliver 10% to 15% savings on our employee benefit costs. How do you do it?
A:
In order to deliver these cost reductions, we have reduced acquisition costs, insurance related costs and margins, administration costs and other related expenses through volume purchasing.
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Q: Do I need to be a AllPharm Association member in order to sign my company up for this program?
A:
Yes. In order to participate in the AllPharm Employee Benefits program, a member must maintain a current Brand Source membership.
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Q: Is life insurance available under the plan?
A:
Yes. $10,000 employee life insurance is standard, although higher and lower limits are available.
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Q: Can AllPharm Employee Benefits provide international coverage?
A:
Yes. The plan provides seamless coverage for domestic and international employees. While abroad, the provider services are tailored to international employees needs.
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Q: What are the maximum limits of the Plan?
A:
$1,000,000 per person annually and up to $2,000,000 per person lifetime.
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Q: What PPO´s are available?
A:
National PPO networks: Beech Street Corporation (Beechstreet.com) and PHCS (phcs.com). Many other PPO networks are available to supplement national network coverage.
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Q: "I am currently a subscriber to an HMO. Is this a better or worse option for me?"
A:
AllPharm Employee Benefits can provide benefits not available to subscribers of many HMO plans. In some circumstances, HMO’s do not have the facilities to provide specialized services such as transplants. Both an HMO and AllPharm Employee Benefits selected PPO have preferred medical providers. With AllPharm Employee Benefits, however, your employees can use non network providers if they are willing to pay the differential in coinsurance and deductible. Individuals that travel may find themselves in an area where they have no HMO coverage. This will not be the case with AllPharm Employee Benefits because there is a National PPO. When plan participants are out of their own local PPO area, they will have access to a PPO. This provides the participants with maximum PPO access.
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Q: "If my doctor is not a part of the PPO, will I need to change doctors?"
A:
No benefit program or insurer has preferred access to all medical providers. Most insurers have a PPO network that they own (or partially own) and insist on that network. AllPharm Employee Benefits will have access to most PPO providers and the administrator will work with the individual employer in the selection of their local PPO. Therefore, the chances are good that your doctor will be a part of the selected PPO. If not, the plan still pays the out of network fees. This would, in most cases, relate only to the doctor and not to a hospital.
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Q: Can AllPharm Employee Benefits be tailored to the needs of my specific company?
A:
Yes. The summary plan description can be amended to include or exclude certain coverage, limits, varying co-payments, co-insurance and out-of-pocket maximums. Additional coverage is also available for vision, dental, group life, and short-term disability.
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| About Administrator |
Q: Who is Dayspring Management LLC?
A:
Dayspring Management LLC is a national management, consulting and administrative firm providing services for national trade associations. Dayspring is owned and managed by actuary Leonard Koloms, FSA, MAAA, CLU, FLMI, RHU and Ronald J. Wilson, DBM, CLU & ChFC. Dayspring Management has been engaged by Brand Source as the Plan Manager and Administrator of AllPharm Employee Benefits. Dayspring Management LLC currently provides services for several national employer associations.
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Q: Who is Medical Benefits Administrators of MD (MBA)?
A:
MBA is a benefit claims administration firm affiliated with R. J. Wilson & Associates Ltd. the reinsurance intermediary providing the insurance for AllPharm Employee Benefits. MBA provides the claims administration for AllPharm Employee Benefits. MBA utilizes the state of the art Trizetto Quiclink System (formerly known as Resource Information Management or “RIMS”) in the management of benefit claims. MBA also employs Solucient Auto Audit and other similar systems as well as INGENIX (formerly Medicode) in the administration of claims.
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Q: What role does MBA have in AllPharm Employee Benefits?
A:
MBA acts as the claims administrator for AllPharm Employee Benefits, providing customer service, medical claims management, adjudication and payment.
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Q: How are employee and dependent benefit rates established?
A:
The Administrator employs the Tillinghast HealthMaps System with specific assumptions reviewed by actuaries to establish contribution rates. The employee and dependent group rates are established based on fixed overhead cost; the cost of medical services in the specific geographic area; the age, sex, family status, and general medical condition of the specific employer group.
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