MEMBER HEALTHCARE BENEFIT PROGRAM (“THE PROGRAM”)
FOR ASSOCIATION/BOARD OF REALTORS MEMBERS
FAQ’S FOR 2019 COVERAGE
HOW DID THE PROGRAM COME ABOUT?
Your Association/Board of Realtors leadership has been looking for a solution that offers its individual Members who currently are not eligible to participate in an employer sponsored group health insurance plan a medical and pharmacy benefit that goes beyond what is available to them individually under the Affordable Care Act (ACA) State or Federal Exchanges. Finding a solution has grown in interest/importance as the options available under ACA Exchanges have experienced significant premium increases, higher and higher deductibles, narrowing provider networks, etc.
WHO IS STRATEGO PARTNERS?
STRATEGO is a Chicago area management consulting firm that has been in business since 2002. STRATEGO works with clients to identify “outside of the box” cost saving strategies, including creative ways to reduce healthcare costs. STRATEGO has been engaged by ABCBOR to identify and coordinate all of the resources required to develop, deliver, support and service the PROGRAM.
WHAT ARE THE PRIMARY BENEFITS OF THE PROGRAM COMPARED TO THE OPTIONS AVAILABLE ON THE ACA EXCHANGES?
The PROGRAM will provide Association Members cost-effective options and a broad national network of hospital and physician providers not currently available under the State ACA Exchange, different annual individual deductible levels ranging from $2,000 to $7,000+, and annual maximum out-of pocket levels that fit different family medical situations and annual budgets.
WHO CAN APPLY TO THE PROGRAM?
All Association Members are eligible to apply to the PROGRAM. The PROGRAM options are available to Association Members. Association Members can apply for individual coverage, individual and spouse coverage, individual and child(ren) coverage or family coverage
HOW DO I APPLY TO THE PROGRAM?
Each Association member who applies to the PROGRAM will be required to complete an on-line application and medical questionnaire. The medical questionnaire will take about twenty to thirty minutes to complete. We recommend that you have information about your doctors, prescriptions and any hospital procedures readily available. If you are applying for coverage for your spouse and/or child you must provide their medical information as well.
WHEN CAN I APPLY TO THE PROGRAM?
The first step in applying to the PROGRAM is completing the medical questionnaire. The on-line medical questionnaire will be available during September 2018. The medical questionnaire must be completed by September 30, 2018.
WHEN WILL I KNOW IF I HAVE BEEN ACCEPTED INTO THE PROGRAM?
All Members who complete their medical questionnaires will be accepted into the PROGRAM. Note: all applications to the PROGRAM are subject to underwriting. The underwriting process takes approximately 2-3 weeks, and there may be follow up questions or additional medical information requested. Email and telephone assistance will be available throughout the application and medical questionnaire completion process so that your questions can be answered in a timely fashion.
You will be informed of your acceptance into the PROGRAM and the amount of your monthly contribution payment during the last two weeks of October, 2018.
WHEN CAN I SELECT MY PLAN AND ENROLL IN THE PROGRAM?
After you receive the monthly contribution amounts, you will be able to enroll on-line in the PROGRAM during the first two weeks in November 2018.
WHEN WILL THE PROGRAM BEGIN?
Coverage under the PROGRAM will begin January 1, 2019. Your cards and information about the PROGRAM will be mailed to you during December 2018.
IF I AM ACCEPTED INTO THE PROGRAM, DO I HAVE TO PARTICPATE?
If accepted into the PROGRAM for January 1, 2019, you are not obligated to participate. If you prefer to keep/renew your current coverage you may do so.
I REALLY LIKE MY DOCTOR. HOW CAN I DETERMINE IF MY DOCTOR IS IN THE PROVIDER NETWORK?
The PROGRAM uses Aetna’s broad national network. You can view the hospitals and physicians in the network by clicking on the following link: www.aetna.com/docfind/custom/mymeritain
CAN I PARTICIPATE IN THE PROGRAM IF I AM ON MY OWN AND RECEIVE MY COMPENSATION AS A 1099 CONTRACTOR?
Yes, the PROGRAM was designed with employers that receive 1099 as their compensation. Members will need to provide their Federal Employer Identification Number (FEIN), even if it has only one employee or owner.
WHAT HAS BEEN THE SUCCESS OF THE PROGRAM SO FAR?
During the 2018 pilot year many C.A.R. Members reported that they saved money, were able to go to hospitals that were out of network in their previous plan and/or were able to go to doctors who were out of network in their previous plan.
WHERE CAN I OBTAIN MORE INFORMATION ABOUT THE PROGRAM?