| About the PHCCare Plus Healthcare
Program: |
Q: What is PHCCare Plus?
A: PHCCare is a new employee healthcare program designed exclusively for PHCC member
employers. It is a fully insured employee benefit plan that meets all federal standards including ERISA and HIPAA. Some of
the major plan features include:
• Comprehensive medical and prescription drug coverage
• Benefits
are fully guaranteed by certain underwriters at Lloyds, London which are rated “A” Excellent by A.M. Best,
an independent rating agency.
• Easy access to local, regional and national PPO networks like PHCS (www.phcs.com) and First Health (www.firsthealth.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
Q: What is the minimum number of employees required to participate
in the program?
A: To qualify for the program, a PHCC member firm must have at least 2 full-time eligible
employees. Firms with four or less full-time employees must have 100% of eligible employees participate in
the program, those with five or more must have at least 75% of eligible employees participating in the program.
If you do not have enough participating employees to qualify for the PHCC Group plan, we also offer Individual/Family
health insurance coverage in most states. For more information about this coverage, please refer to the Individual Health section of the website.
Q: How do I get a Quote for the PHCCare Plus Health Plan?
A: Simply complete the Quote Request Form located on the FORMS page of this website. Once completed, fax or email this form to quotes@phccare.com . If you have any questions about completing the form, please call a licensed PHCCare Benefit Consultant toll-free at 866-641-8982.
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Q: Is the PHCCare Plus Group
Benefit Plan categorized as insurance?
A: The PHCCare Plus Group Benefit Plan 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 the PHCC Group Benefit Plan 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 the PHCCare Plus Program 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 PHCC member in order to sign my company up for this program?
A:
Yes. In order to participate in the PHCC Group Benefit program, a company must maintain a current PHCC membership.
Non-member firms may request a quote from the program but they must join PHCC before enrolling in the Medical Plan.
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Q: Is life and disability insurance available
under the plan?
A: Through a partnership with Reliance Standard Life Insurance Company, we
can offer group disability insurance (both short term and long term) and group life insurance coverage to PHCC members.
Amounts range from $10,000 per employee to 2X annual salary. Please ask your PHCCare Benefit Consultant for more details
on these benefits.
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Q: Can the PHCCare Plus Program
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 covered person annually and $2,000,000 per covered person lifetime.
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Q: What Provider Networks are available?
A:
National PPO networks: Private Healthcare Systems (www.phcs.com). and First Health (www.firsthealth.com) are the primary national networks. Many other PPO networks are available to supplement national network coverage -
to see a full listing of PPOs available by state go to the PPO Networks page of this website.
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Q: We are currently covered
through an HMO. Is this a better or worse option?
A: The PHCCare Plus Medical
Program 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 the PHCC Medical Program have
preferred medical providers. With PHCCare Plus, 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 the PHCC Healthcare Program 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. The PHCCare Plus Plan has 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 the PHCCare
Plus Group Medical Program 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, and group life coverage.
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Q: Who is Medical
Benefit Administrators of MD (MBA)?
A: MBA is a national benefit administration
firm retained by PHCC and the Plan Administrator to provide claims and administrative services to the plan.
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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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Q: Who is Affintiy Benefit Services?
A: Affinity
Benefit Services has been retained by PHCC and the Plan Administrator to provide enrollment services for the PHCCare
Plus program. They will work with the various individual PHCC member companies across the United States that wish
to participate in the PHCC Group Benefit Trust program.
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