FAQs for Members / Employees
General FAQs
A. The SB/A CoOp uses First Health Provider Network, one of the largest network of Hospitals, Clinics, and Physicians in the USA.
A. The Employer Freedom Plan utilizes the First Health PPO Network for medical services. First Health PPO is wholly owned by Aetna. Our belief is that the best network is not necessarily the one that has a slight discount advantage; it is one that:
- Offers extensive patient access to network providers
- Offers competitive or lowest actual dollar pricing – not stated discounts
- Excludes or minimizes contract language default pricing
- Utilizes best in class providers based on treatment outcomes
The Employer Freedom Plan utilizes ProCare Rx for prescription and pharmacy needs.
- ProCare Rx is a full-service Pharmacy Benefit Manager (PBM)
- Over 70,000+ pharmacies in the national network
- Value based low net cost formulary with trends below national growth rates for the last 10 years
- USA based customer service representatives 24/7/365
The Employer Freedom Plan utilizes the Careington Discount Dental Plan. Careington is one of the most recognized professional dental networks in the nation. Careington works with 62,000+ participating dentists.
- Save 20% to 60% on most dental procedures
- Not insurance. Discount plans can be used continuously with no capped services.
- Highly selective credentialing standards
- Members may visit any participating dentist in the network at any time
- Membership extends to all members of the family, throughout all 50 states
A. Free Market Administrators (FMA) was created with over 100 years of experience health care at the Senior Executive Level. We are committed to creating value for our broad client base of both fully insured major medical and self-funded clients. FMA continues to be a critical measure for which we have maintained the highest performance standards within the industry. FMA remains focused on not only exceeding the highest ethical standards in the industry, while upholding the utmost integrity for our clients, but also redefining the way our clients look at the world of health care benefits.
A. Free Market Administrators, your plan administrator, will provide you with a medical identification card (ID card) that will include important member and plan information.
As a member, you will present your Medical ID card to a health care provider and pharmacist as you would with any other health care coverage ID card. The provider will verify for membership eligibility and provide your service. The provider will process the claim directly with the plan administrator. Most of the time you will not pay anything at point of service. Some providers on some services may request a portion of your share of the co-insurance.
If you are choosing to utilize your $20.00 co-payment benefit, remember to mention the co-payment for limited services at your provider.
If you are intending to use your Affordable Care Act (ACA) coverage, you must verify as such and that your provider will submit the proper CPT codes. Failure to do so will result in your billing submission to reflect your regular zero deductible 50/50 co-insurance amounts due.
Remember to verify your provider is in First Health network.
A. If care is needed, call the plan administrator phone number provided on medical ID card. Verify coverage, pay at point-of-service and submit claim to plan administrator for adjudication and resultant reimbursement.
A. One factor is The Freedom Plans reside inside of the Small Business Agency CoOp non-profit corporation. Secondly, there are coverage caps and by purchasing only the amount of care you might anticipate over the year, you can save a lot on your health care coverage.
A. Enrollees evaluate the plans and select a coverage limit or “cap”. This cap represents the upper limit of care provided. Supplemental benefits or catastrophic plans may be added for additional coverage.
A. There are no waiting periods on basic level benefits or preventive care benefits. However, extended (enhanced) inpatient/outpatient benefits have a 90 day waiting period or 10 month waiting period depending on condition.
A. There are no front-end deductibles.
A. Yes, members will have access to 24 Hr. Virtual Clinic which allows members to call and speak to a state board certified physician who will be able to triage the patient and if required, prescribe appropriate medications to be picked up at a member pharmacy.
A. Careington Dental has been serving the dental community for over 20 years. Committed to making quality care more accessible and more affordable, Careington offers discount dental plans which offer continuous discounted services, without limits on use.
A. If you have questions about any features, benefits, and exclusions prior to enrolling, it is suggested you view the tutorial on the DACFreedomPlan.com website and click the Training Portal in the navigation bar.
If reviewed and still looking for answers, please call the SB/A CoOp Customer Service Representatives at (303) 566-0353.
Note: If you are already enrolled then you will call the plan administrator customer service number located on your medical ID card.
SB/A CoOp FAQs
A. The SB/A CoOp is a Non-Profit Agency Cooperative Corporation that does not buy or sell products or services, but acts as the legal Collective Agent of all the Cooperative Members to facilitate advantageous relationships for and between its members. The SB/A CoOp may legally aggregate small business employers together without becoming a Multiple Employer Welfare Association (MEWA) or acting as a Multiple Employer Trust (MET).
A. Business owner members pay $24 annually, which renews January 1 of each year.
A. The Freedom Plans utilize the FirstHealth PPO network for the medical services. FirstHealth PPO is wholly owner by Aetna. Our belief is that the best network is not the one with a 2% discount advantage; it is one that:
- Offers extensive patient access to network providers
- Offers competitive or lowest actual dollar pricing – not stated discounts
- Excludes or minimizes contract language default pricing
- Utilizes best in class providers based on treatment outcomes
ProCare Rx is the full-service Pharmacy Benefit Manager (PBM) and has a nationwide network of over xxx-member pharmacies that includes major national and regional retail chains and independent pharmacies.
A. Free Market Administrators (FMA) administers The Freedom Plans’ medical benefits on behalf of the SB/A Coop’s members. FMA is a Third-Party Administrator (TPA) headquartered in Addison, Texas. FA serves employer clients with members in the lower 48 states. FMA has teamed up with best-in-class business partners, from leading PPO networks in each geographic area, to care management companies, telemedicine providers, and transparency tools – all the components needed to manage costs and provide a great member experience. FMA has been in business for over 25 years and is recognized nationally as a premier independent third-party health plan administrator and resides under the umbrella of Regional West Health Services, western Nebraska’s largest provider of health care services.
ProCare Rx administers The Freedom Plans’ pharmacy benefits. ProCare Rx has been in business for over 30 years and remains an independent, privately held, full-service Pharmacy Benefit Manager (PBM) with a nationwide network of over 66,000-member pharmacies. ProCare Rx’s services, technology, and pharmaceutical pricing contracts are considered the be the best in the industry.
A. The SB/A CoOp sponsors a self-funded medical employee benefits program that is fully compliant with ERISA. ERISA supersedes the Affordable Care Act and grants an employer the ability to offer non-conforming ACA medical benefits that are more affordable, providing the employer meets specific ERISA mandated requirements – in writing, funding, and non-discriminating in-benefit levels and eligibility.
A. The SB/A CoOp offers medical health benefit plans that also include the Minimum Essential Coverages (MEC) as was required under the original Affordable Care Act. This includes Preventative Care, Routine Well Care, Adult Preventative Services and Screenings, Woman Preventive Services and Screenings, Child Preventive Services and Screenings, and 100% of ACA Mandated Prescriptions such as birth control.
A. Zero deductibles, first dollar coverage, low out-of-pocket maximums, no pre-existing condition exclusions, no waiting periods*, Affordable Care Act Preventative (MEC- Minimum Essential Coverage) covered at 100%, pharmacy prescription, Virtual Clinic 24/7, dental and vision discount plan.
*Extended Inpatient and Outpatient Benefit Provision is effective 90 days after effective date of member; Maternity Inpatient and Outpatient services are effective 10 months after the effective date.
A. Major Medical plans combine the every day health care plan with a catastrophic plan, and usually include a high deductible that must be met. The SB/A CoOp is a non-profit corporation which reduces premiums, and the plans have coverage “caps”, which further reduce the premiums, and offer zero deductibles with 50/50 coinsurance with first dollar coverage.
ERISA FAQs
A. The Employee Retirement Income Security Act of 1974 is a Federal law that sets minimum standards for most voluntarily established retirement and health plans in private industry to provide protection to individuals In these plans.
A. ERISA products are regulated by the Federal Government and was established by Congress. The traditional insurance companies and their products are regulated by each of the 50 states through their individual departments of insurance.
ERISA sets the standards of conduct for those who manage an employee benefit plan and its assets (called fiduciaries). An ERISA-covered group health plan is an employment-based plan that provides coverage for medical care, including hospitalization, sickness, prescription drugs, vision, or dental.
A. COBRA, HRA’s, HSA’s, FSA’s (flexible savings accounts), 401k Plans, Pension Plans, Dental Insurance Plans, Vision Insurance Plans, Cooperatives, EAP’s (Employee Assistance Plans), Life Insurance Plans, Prepaid Legal Service Plans.