Allpharm Benefits (also known as Allpharm Employee Benefit Trust) is a welfare benefit trust established and controlled by the elected Trustees of member employers of AllPharm Association. Allpharm Benefits was established to secure the benefits provided to employees and dependents of member employers of the AllPharm Association. Participation in the Allpharm Benefits plan is contingent upon the employer maintaining membership in AllPharm Association.

Allpharm Benefits provides major medical, prescription drug, dental, and vision benefits for the employees and dependents of AllPharm Association member employers. All benefits provided under the Allpharm Benefit Trust are subject to the Employee Retirement Income Security Act (ERISA) of 1974 as amended including such provisions for COBRA and HIPAA and all other federal benefit mandates. Each employer may select and provide the benefit plan that fits their pocketbook and the needs of their employees and dependents.

Group healthcare rates for each participating employer group are based on the discounted cost of benefits in the geographic area where the employees and dependents reside, their actual age, sex, family status and the general medical condition of the employer group. Each participating employee receives a Summary Plan Description (rather than an insurance certificate or policy) describing all the benefits provided. Each employee receives an identification card showing the selected preferred provider.

The Allpharm Benefit Trust is not in and of itself deemed to be insurance. The Trustees of the healthcare plan however, purchase insurance direct from the world insurance market under one policy to further secure the benefits provided. Under this insurance arrangment all eligible medical benefits are guaranteed from the first eligible dollar to the limits set forth in the Summary Plan Description by qualified “A” rated Underwriters at Lloyd’s, London.

The insurance provided by certain Underwriters at Lloyd’s, London for the healthcare portion of the Plan is provided through R. J. Wilson & Associates Ltd., a reinsurance brokerage house and direct correspondent with Underwriters at Lloyd’s, London. This is placed net of any commission or remuneration to R. J. Wilson & Associates Ltd.

Dayspring Management LLC is a national management, consulting and administrative firm providing services for national trade associations. Dayspring has been engaged by AllPharm Association as the "Plan Administrator" and manager of the Allpharm Benefit Trust. Dayspring currently provides services for several national employer associations. Dayspring assists the Trustees with all federal filing requirements.

Medical Benefits Administrators of MD, Inc (MBA) is the "Claims Administrator" of the Allpharm Benefit Trust appointed by Dayspring. MBA provides claims adjudication and processing services on behalf of the Allpharm Benefit Trust. MBA, a well known Claims Administrator employs the latest state of the art information and benefit processing systems.

Group life and AD&D coverage is also available through an “A” rated national group life insurance company. Group life and AD&D claims are handled directly by that insurer.

Major Plan Features

Major Medical

Comprehensive Major Medical Benefits are provided for up to $1,000,000 per employee (and dependents) on a per person, per year basis, with a lifetime maximum of $2,000,000 per person, per year. Benefits under the plan are subject to all federal provisions, regulations and mandates such as "ERISA", "COBRA", and "HIPAA." Employer group rates are established actuarially based on the demographics of the specific group. Absent general group claims experience, individual medical information may be required at inception but such information is used for group rating purposes only. Additional new employees will be added subject to the rules of HIPAA.

Fully Insured

All healthcare claims are fully guaranteed by certain qualified “A” rated Underwriters at Lloyd’s, London. Under the insurance arrangement the insurers become directly liable to the eligible employee or dependent for the full amount of any eligible claim incurred during the Period of Insurance if the claim is not paid within 30 days of final determination under the claims procedures established per ERISA guidelines and set forth in the Summary Plan Description.

Contributions

The rates are based on the current geographical cost of medical services in the specific zip code of the employees and dependents, modified by the other demographics of the employer group. Overall rates may be adjusted up or down each six months to allow for more accurate trending of the cost of medical services and avoid overly conservative long term trend factors and double digit rate increases at renewal.

Preferred Providers

Before you change doctors, we’ll change networks. The Allpharm Benefit Trust has access to over 60 National & Regional PPO networks. To see a complete list go to our PPO list.

Utilization

Each employee has access to a toll free line that they may call 24 hours per day, 7 days per week for pre-certification of inpatient, outpatient, elective procedures, diagnostics, therapies, network guidance, and other needs. The utilization program includes concurrent, and retrospective review, as well as a second opinion program. The benefit plan also includes large claim management services with a focus to facilitate more individualized and coordinated care.

Claims Administrator

All claims administration services are provided by or through MBA for one level management fee to reduce cost. MBA adjudicates and processes all claims on behalf of the Plan.

Other Benefits

Optional dental and vision coverage is also available. The Allpharm Benefit Trust also provides a selection of fully insured group life, accidental death and dismemberment coverage written on a true group basis for groups of ten or more. Group Life AD&D claims are handled direct by the group life insurance company.