| About the MBCEA Health
Program |
Q: What is the MBCEA Health
Program?
A: It is a new, non-profit employee healthcare program designed exclusively
for member firms of the Metal Building Contractors & Erectors Association, and their employees/dependents.
Benefits are provided through the Specialty Contractors Benefit Trust, 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 qualified “A” rated insurers
• 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 of covered benefits per participant per year
• All benefits are fully guaranteed to the
1st eligible dollar
• Plan deductibles starting as low as $250
• All MBCEA firms with 2 or more full-time
employees are eligible
Q: What is the minimum number of employees required to participate in the program?
A: To qualify for the program, an MBCEA 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 group IDA 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.
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Q: Is
the MBCEA Health Benefit Program categorized as insurance?
A: The MBCEA Health
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 (see the Plan Brochure for more details). The benefits under the Specialty Contractors Benefit Trust are guaranteed in full from the first
eligible dollar to the limits of the plan by qualified “A” rated underwriters at Lloyds, London.
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Q: Will the MBCEA Health Program save my company money?
A: Each employer may select and provide the benefit plan that fits their budget. All other
things being equal, the cost of providing benefits under the new MBCEA Health Benefit Program could reduce an employers
healthcare costs by 10% - 15%, and in some cases as much as 20% or more when compared with similar coverage offered by "For
Profit" commercial heatlh insurers and Blue Cross/Blue Shield 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 by pooling many MBCEA members under a single large group health program.
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Q: Do I need to be a member of Metal
Building Contractros & Erectors Association to sign my company up for this program?
A:
Yes. In order to participate in the MBCEA Health Benefit Program, a company must maintain a current membership in
the MBCEA. However, non-member firms may receive a program quote.
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Q: Is life and disability insurance available under the plan?
A:
Yes. MBCEA members may purchase Group Life insurance coverage in flat amounts of $25,000 or $50,000, or an amount
equal to one or two times an employee's annual salary. This life insurance is NOT provided through the Specialty
Contractors Benefit Trust, but rather through an unrelated life insurer rated A "Excellent" (or better) by A.M.
Best and Company, a leading independent insurance company rating agency. Short and Long Term disability coverage is also available
thorugh a separate company.
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Q: Does
the MBCEA Health Program provide international coverage? A: Yes. The plan provides
seamless coverage for U.S.-based employees of MBCEA member firms who travel internationally. 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: The standard coverage limits
are $1,000,000 per covered person annually and $2,000,000 per covered person lifetime. Participating groups may
also choose $5,000,000 of lifetime coverage at additional expense.
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Q: What PPO´s 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.
For a full list of PPO networks, including doctors and hospitals participating in the networks, please go to our PPO Networks page.
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Q: We currently subscribe to an
HMO. Is this a better or worse option for our employees?
A: The MBCEA Health 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 MBCEA Program have preferred medical providers.
With the MBCEA Program, 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 MBCEA 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 Network, 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 MBCEA Health 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 benefits.
This would, in most cases, relate only to the doctor and not to a hospital.
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Q: Can the MCEA Health Benefit Program be tailored to the needs of my specific
company?
A: Yes. The MBCEA Health plan benefits are flexible, so each member
firm can choose the from among varying deductibles, co-payment options, co-insurance levels, and coinsurance maximums and
other plan features to customize a plan to meet their specific employee needs and budget. Optional coverage is also available
for vision, dental, and group life/disability coverage.
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Q: Who is Medical Benefits Administrators of MD (MBA)?
A:
MBA is a full service benefit administration firm specializing in national employer association benefit programs. MBA is an
affiliate of R. J. Wilson & Associates Ltd. the reinsurance intermediary negotiating the insurance for the Trustees of the
Specialty Contractors Benefit Trust and other national association benefit programs. MBA utilizes the state of the art
Trizetto Quicklink System (formerly known as Resource Information Systems or “RIMS”) in the management of benefit
claims. MBA also employs Solucient Auto Audit and other similar systems and has access to INGENIX (formerly Medicode) data
in the administration of benefit claims. |
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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 LLC (ABS)?
A: Affinity Benefit Services has been retained by MBCEA
and the Plan Administrator to assist MBCEA member firms in the evaluation, implementation, design, presentation, and
enrollment of employees and dependents under the MBCEA Health Benefit Program. |
