| About ISPACare™: |
Q: What is ISPACare™?
A: ISPACare™ is
a new employee healthcare program designed exclusively for member firms of the International Sleep Products Association,
and their employees/dependents. Benefits are provided through the ISPA Group 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
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Easy access to local, regional and national PPO networks like
PHCS (www.phcs.com) and First Health (www.firsthealth.com)
• Optional coverage is available for vision, dental, group
life, and short-term disability
• Up to $1 million per covered person per year
• All benefits are fully guaranteed to the 1st eligible dollar
• Plan deductibles starting as low as $250
Q: Who is eligible for
the ISPACare™ Program?
A: The eligiblity requirements are included below: |
Q: Is the ISPACare™ Plan categorized
as insurance?
A: The ISPACare™ 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 ISPA Group 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 ISPACare™ 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 ISPACare™ Program could reduce an employers healthcare
costs by 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 ISPA members under a single large group health program.
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Q: Do I need to be a member of International
Sleep Products Association in order to sign my company up for this program?
A: Yes. In
order to participate in the ISPACare™ Program, a company must maintain a current membership in ISPA.
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Q: Is life insurance available under the plan?
A: Yes. ISPA 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 ISPA Group 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.
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Q: Can the ISPACare™ Member Health Program provide international
coverage?
A: Yes. The plan provides seamless coverage for U.S.-based employees of ISPA 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: $1,000,000 per covered person annually and $5,000,000 per covered person lifetime.
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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 ISPACare™ Member
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 ISPACare™ Program have
preferred medical providers. With the ISPACare™ 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 ISPACare™ 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 ISPACare™ 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 ISPACare™ Program be tailored to the needs of my specific company?
A: Yes. The
ISPACare™ 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 ISPA Group 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 ISPA and the Plan Administrator to assist ISPA member firms in the
evaluation, implementation, design, presentation, and enrollment of employees and dependents under the ISPACare™ Member Health
Program. |
