General Plan Overview

The MBCEA Health Benefit Program is offered through the Specialty Contractors Benefit Trust, a non-profit trust sponsored by the Metal Building Contractors & Erectors Association. The MBCEA Healthcare Program was established to provide health benefits to employees and dependents of eligible MBCEA member firms, which includes both contractor and manufacturer/supplier members of MBCEA, along with their affiliated companies. Participation in the MBCEA Health Plan is contingent upon the employer maintaining MBCEA membership status.

The MBCEA Health Program provides major medical, prescription drug, dental, and vision benefits for the employees and dependents of MBCEA member firms. All benefits provided under the MBCEA Health Program are subject to the Employee Retirement Income Security Act (ERISA) of 1974 as amended, including provisions for COBRA and HIPAA and all other federal benefit mandates. Each employer may select and provide the benefit plan that fits their budget and serves the needs of their employees and dependents.

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 benefits provided, and an identification card showing their selected preferred provider network.

The Specialty Contractors Benefit Trust is not in and of itself deemed to be insurance. The Trust, however, purchases insurance directly from the world insurance market under one policy to GUARANTEE that all benefits and claims will be paid to Trust participants. Under this insurance arrangement, all eligible medical benefits are guaranteed from the first eligible dollar to the limits set forth in the Summary Plan Description by certain underwriters which are rated A "Excellent" by A.M. Best and Company, a leading independent insurance rating organization.

Medical Benefit Administrators of MD (MBA) is the "Claims Administrator" for the Specialty Contractors Benefit Trust.  MBA provides claims adjudication and processing services on behalf of the Trust, and utilizes 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.

MBCEA Health Benefit Program 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 an unlimited lifetime maximum per person. 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 time of enrollment, but such information is used for group rating purposes only. Additional new employees will be added subject to the rules of HIPAA.

Fully Guaranteed

All MBCEA Health Program claims are fully guaranteed by certain qualified “A” rated underwriters. 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

The MBCEA Health Benefit Program has contracts with over 20 National & Regional Preferred Provider networks. We also have the ability to contract with new networks - if you have a specific PPO network or physician/hospital group that you would like to see added to the PPO list that is currently contracted with the program, please contact us at 866-641-8981 with full details.

Pre-Certification/Case Management

Each participating employee has access to a toll free phone number 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 benefit plan also includes large claim management services (case management) with a focus on facilitating more individualized and coordinated care for plan participants.

Claims Administrator

All claims administration services are provided or coordinated through MBA to increase administrative efficiencies and minimize costs. MBA adjudicates and processes all claims on behalf of the Plan.

Other Benefits

Optional dental and vision coverage is also available through the Specialty Contractors Benefit Trust. The MBCEA Health Benefit Program quote may also include a selection of fully insured group life, accidental death and dismemberment coverage, and short and long-term disability coverage for MBCEA members. Billing and claims services for these products are handled directly by the issuing carriers.