FAQ’s for Members and Employees
A. The Employer Freedom Plan primarily utilizes 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
Serve You Rx is the full-service Pharmacy Benefit Manager (PBM) and has a nationwide network of over 66,000-member pharmacies that includes major national and regional retail chains and independent pharmacies.
A. Regional Care Inc. (RCI) administers the Employer Freedom Plan medical benefits on behalf of the SB/A Coop’s members. RCI is a Third-Party Administrator (TPA) headquartered in Scottsbluff, Nebraska. RCI serves employer clients with members in the lower 48 states. RCI 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. RCI 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.
Serve You Rx administers the Employer Freedom Plan pharmacy benefits. Serve You 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. Serve You Rx’s services, technology, and pharmaceutical pricing contracts are considered the be the best in the industry.
A. The Employer Freedom Plan will provide an Identification Card (ID Card) that will include important member and plan information. As a member, you will present your ID Card to a health care provider and pharmacist as you would with any other health care coverage ID Card. RCI and Serve You Rx will process the health care claim and pay the providers directly for the Employer Freedom Plan’s portion of the health care expense.
For medical claims, RCI will adjudicate the claim and send to the member an Explanation of Benefits (EOB) identifying the amount paid to the health care provider. You can then expect that the health care will balance bill the member (patient) for those FirstHealth PPO discounted health care expenses not covered by the Employer Freedom Plan.
Serve You Rx is the full-service Pharmacy Benefit Manager (PBM). When the member presents their prescription to the pharmacist at one of Serve You Rx’s nationwide network pharmacies, the pharmacist will confirm the member’s coverage on their system and collect the member’s portion of the discounted cost when dispensing the medication.
A. For any questions, the member ID Card provides customer service phone numbers. For medical care coverage questions, please call RCI. For pharmacy questions, please call Serve You Rx.
A. Direct Dental Plans of America (DDP) offers a discount dental program. You may find that the value of DDP’s discounted program is a terrific option:
- The DDP programs utilizes the Aetna Dental Access Network. In most instances, save 15% to 50% per visit* on services from General Dentistry and Cleanings to Root Canals and Crowns to Braces and Dentures.
- The Aetna Dental Access Network has over 213,000 available dental practice locations nationwide – specialty dental care (such as Orthodontics and Periodontics) is available when required.
Direct Dental Plans of America (DDP) also offers a discount vision program:
- The DDP vision program utilizes the Coast to Coast Vision Network. Receive 20% to 60% off prescription eyewear including most frames, lenses and specialty items such as tints, coatings and UV protection, 10% to 30% off Eye Exams, and 40% to 50% off the national average cost of LASIK surgery.
- Over 20,000 providers nationwide, including local retailers and national chains – JCPenney Optical, LensCrafters, Pearle Vision, Sears Optical, Target Optical and more.
A. Simply explained, health care insurance premiums are based on:
- The price/cost of healthcare services, drugs, and medical devices
- The “number of” (“or acceleration growth of”) of healthcare services, drugs, and medical devices
- Administrative and risk cost to process and oversee the management of a healthcare program
- Plan design that allocates cost sharing by the patient, i.e. deductibles, coinsurance, and out of pocket limitations
- On average, the health status of Americans is eroding due to increasing chronic conditions related to age, obesity, and lifestyle – many of these chronic conditions are changeable or treatable with diet, exercise, and maintenance medications.
- Insurance companies price their insurance rates (risk pools) to pay for catastrophic claims so that lower health care users pay for high health care users.
80%+ of Americans incurs less than $10,000 per year in health care expenses/services. The Employer Freedom Plan was designed for those Americans seeking comprehensive first dollar coverage but lower cost health care coverage that meets their everyday needs.
A. ERISA stands for Employee Retirement Income Security Act. It is administered and enforced by three bodies: Labor Department’s Employee Benefits Security Administration, the Treasury Department’s Internal Revenue Service, and the Pension Benefit Guaranty Corporation. ERISA protects the interests of employee benefit plan (retirement and health & welfare) participants and their beneficiaries. It requires plan sponsors to provide plan information to participants and establishes standards of conduct for plan managers and other fiduciaries. ERISA does not require employers to establish benefit plans and it does not require that plans provide a minimum level of benefits. Instead, it regulates the operation of a benefit plan once it has been established. ERISA preempts all state laws that relate to any employee benefit plan, with certain, enumerated exceptions.