To
walk you through the process, we have answered some of the
most frequently asked questions regarding the Physicians
Health Benefits healthcare
program.
| About Physicians Health Benefits |
Q: What is the Physicians Health Benefit Trust healthcare plan?
A:
Physicians Health Benefit Trust is a new employee healthcare program designed exclusively for member employers. It is a fully insured employee benefit plan that meets all federal standards including ERISA and HIPAA.
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Q: Is Physicians Health Benefit Trust categorized as insurance?
A:
Physicians Health Benefit Trust 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. The benefits under the Physicians Health Benefit Trust are guaranteed in full from the first eligible dollar to the limits of the plan by qualified “A” rated underwriters at Lloyd’s London.
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Q: Will Physicians Health Benefit Trust save my company money?
A:
Each employer may select and provide the benefit plan that fits their budget and all other things being equal, the cost of providing benefits under the new Plan has been reduced by 20% and in some cases as much as 35% or more when compared with other available commercially insured group benefit 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 35% or more 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 through volume purchasing.
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Q: Do I need to be a PHA member in order to sign my company up for this program?
A:
Yes. In order to participate in the Physicians Health Benefit Trust program, a member must maintain a current PHA membership.
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Q: Is life insurance available under the plan?
A:
Yes. $5,000 employee life insurance is standard, although higher and lower limits are available.
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Q: What are the maximum limits of the Plan?
A:
$1,000,000 per person annually and up to $2,000,000 per person lifetime for staff members and their families, $1,000,000 per person annually and up to $5,000,000 for physicians and their families.
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Q: "I am currently a subscriber to an HMO. Is this a better or worse option for me?"
A:
Physicians Health Benefit Trust 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 Physicians Health Benefit Trust selected PPOs have preferred medical providers. With Physicians Health Benefit Trust, 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 Physicians Health Benefit Trust 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: 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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