FAQs
We’re Here To Answer All Your Questions
Alternative to PPO (Indemnity) FAQs
Do I have to wait until open enrollment to start my Health Insurance Plan?
No. You can enroll in several private plans all year long.
Who is the Insurance Company?
We work with a variety of top-rated insurance companies, which depends on your
individual needs and type of policy.
individual needs and type of policy.
Why are these plans more affordable than employer plans/traditional health insurance?
Our PPO plans and Major Medical type plans are underwritten based on your health,
not your financial situation. If you’re relatively healthy at the time of enrollment and
approval, our PPO plans can help save you thousands of dollars in monthly premiums
and deductibles.
not your financial situation. If you’re relatively healthy at the time of enrollment and
approval, our PPO plans can help save you thousands of dollars in monthly premiums
and deductibles.
Will I have to take a physical or submit medical records?
No. We will simply ask you a few medical questions and submit your responses directly to the company. For your protection, the company will verify your answers are correct. No need for medical record submission.
How are premiums so low?
The companies we represent insure primarily healthy customers and do not spend excessive marketing dollars on advertising. This transfers the savings onto the customer in the form of lower monthly premiums and low or no deductibles. This allows us to customize the coverage based on your specific needs and budget.
What happens if I get sick?
Once the policy is effective, our plans are guaranteed renewable and will not end coverage based on claims. Several of our plans will automatically renew every 12 months until you reach the age of 65, choose to cancel your plan, or if your plan lapses due to non-payment.
Do I have to pay money upfront?
Based on the company you select, premiums will be charged on either the approval date or the future effective date.
Will the application process take a lot of time?
Once you have decided on your customized plan, the application process is only about 10 minutes to complete.
Where can I use my coverage?
Based on the company you select our indemnity plans allow you to use your benefits with any provider in the USA, with an optional nationwide PPO network for possible additional savings. Our major medical plans and semi-limited medical plans can be used within the nationwide PPO networks.
What is self-pay?
Indemnity plans allow the customer to pay for medical expenses upfront “self-pay”. Then the customer submits their paperwork to the Insurance company via app or online portal for reimbursement. This allows them to maximize their benefits.
If I do self-pay, how do I submit a claim?
Customers have easy access via app or online portals to file claims anytime you do self-pay, and Juan is also available to help you.
ERISA PPO Plan FAQs
What is an ERISA Plan?
An ERISA plan is any employer-sponsored group health benefit plan in the private
sector that falls under the Employee Retirement Income Security Act (ERISA).
sector that falls under the Employee Retirement Income Security Act (ERISA).
What is an example of an employer who offers an ERISA plan?
A Research Corporation that is dedicated to enhancing global well-being by delivering actionable national health insights and wellness market statistics. They employ Research Associates (RAs) to provide information about their health and consumer habits. Employees complete activities in return for guaranteed payments. W- 2s are issued to the employee.
Who can qualify as a hired Research Associate?
Any prospective individual who meets the employment standards and agrees to the terms of employment. Employment standards have some health questions as they are hiring healthy people to answer healthy people surveys.
What benefits are afforded to Research Associates?
Active Research Associates will be eligible to participate in group medical and wellness benefits. Benefits are made available to other similarly situated Research Associates in return for timely payment of premiums. Failure to pay premiums timely may result in loss of coverage under the terms of the plan.
What are the expectations of a Research Associate?
Each month, Research Associates will be sent an email and/or text for the opportunity to add to their de-identified and anonymous data set by participating in a health research activity. Health research activities are accessed through their Research Associate portal. The dashboard also is the employee’s single site for accessing and understanding their benefits. Activities can vary, such as surveys, videos, quizzes, protocols, health coaching, telemedicine, healthcare satisfaction utilization surveys, and others. In return for sharing their data, the Research Corporation will pay them a payment.
If a Research Associate chooses not to complete activities, will this result in termination?
Activities are optional but encouraged as they help monitor and improve health, reducing the risk of dangerous health conditions and lowering healthcare costs. Failure to perform activities may result in termination of employment.
What are qualified health activities?
Research Associates are compensated at an hourly rate for completing health research activities. Payment is calculated on a pro rata basis according to the time spent on each task. Each activity is designed to take 15 minutes or less to complete. Examples of activities include watching videos, surveys, health coaching, logging vitals, and many more!
Who has the option to complete activities in their employee portal?
The employee who holds the Research Associate status is the individual who may complete activities in their employee portal.
When do employee benefits recurring payments come out?
Benefit payment auto-drafts on or around the 15th of each month.
How do Research Associates look up their current providers to make sure they are contracted with the network?
To search for a provider, please access the link below. Additionally, networks
regularly update their provider network list. It is recommended that current or potential
employees check with their provider to confirm participation in their selected network.
PHCS PPO
1.) Highlight PHCS (Logo on front card) and click Select and Search
2.) Enter your search parameters, your zip code, and select Search.
Can changes be made to the policy, i.e., add dependents, move up or down plan levels, change effective dates, etc.?
Changes can be made during the open enrollment period. Outside of open enrollment, changes require a Qualified Life Event (QLE).
Can I cancel at any time? What are the restrictions?
Employees may cancel at any time. No partial refunds are given. For example, if an employee cancels on November 15th, they will be covered for the remainder of November, will not be charged again, and will no longer be covered starting December 1st.
Is My Doctor or Medical Facility In-Network?
Please click on your carriers' link found below:
Manhattan Life Plans:
United Healthcare (United Health One) Plans:
Philadelphia American Plans:
Still have questions? Click “CONTACT” to reach out to Juan directly.
We’re always here to help!