General Plan Overview

The ISPACare™ Member Health program is offered through the ISPA Group Benefit Trust, a non-profit established by the International Sleep Products Association and guided by ISPA members who serve as Trustees for the program. ISPACare™ was established to provide health benefits to employees and dependents of eligible ISPA member firms, which includes both manufacturer and supplier members of ISPA, along with their affiliated companies. Participation in the ISPACare™ plan is contingent upon the employer maintaining ISPA membership status.

ISPACare™ provides major medical, prescription drug, dental, and vision benefits for the employees and dependents of ISPA member firms. All benefits provided under the ISPACare™ program are subject to the Employee Retirement Income Security Act (ERISA) of 1974 as amended, including provisions for COBRA and HIPAA and all other federal benefit mandates. Each employer may select and provide the benefit plan that fits their budget and serves the needs of their employees and dependents.

Healthcare rates for each participating employer group are based on the discounted cost of benefits in the geographic area where the employees and dependents reside, their actual age, sex, family status and the general medical condition of the employer group. Each participating employee receives a Summary Plan Description (rather than an insurance certificate or policy) describing all benefits provided, and an identification card showing their selected preferred provider network.

The ISPA Group Benefit Trust is not in and of itself deemed to be insurance. The Trust, however, purchases insurance directly from the world insurance market under one policy to GUARANTEE that all benefits and claims will be paid to Trust participants. Under this insurance arrangement, all eligible medical benefits are guaranteed from the first eligible dollar to the limits set forth in the Summary Plan Description by certain underwriters at Lloyds, London which are rated A "Excellent" by A.M. Best and Company, a leading independent insurance rating organization.

Medical Benefit Administrators of MD (MBA) is the "Claims Administrator" for the ISPA Group Benefit Trust.  MBA provides claims adjudication and processing services on behalf of the Trust, and utilizes the latest state-of-the-art information and benefit processing systems.

Group life and AD&D coverage is also available through an “A” rated national group life insurance company. Group life and AD&D claims are handled directly by that insurer.

ISPACARE™ Plan Features

Major Medical

Comprehensive Major Medical Benefits are provided for up to $1,000,000 per employee (and dependents) on a per person, per year basis, with a lifetime maximum of $5,000,000 per covered person. Benefits under the plan are subject to all federal provisions, regulations and mandates such as "ERISA", "COBRA", and "HIPAA." Employer group rates are established actuarially based on the demographics of the specific group. Absent general group claims experience, individual medical information may be required at time of enrollment, but such information is used for group rating purposes only. Additional new employees will be added subject to the rules of HIPAA.

Fully Insured

All ISPACare™ Member Health Program claims are fully guaranteed by certain qualified “A” rated underwriters at Lloyd’s, London. Under the insurance arrangement the insurers become directly liable to the eligible employee or dependent for the full amount of any eligible claim incurred during the Period of Insurance if the claim is not paid within 30 days of final determination under the claims procedures established per ERISA guidelines and set forth in the Summary Plan Description.

Contributions

The rates are based on the current geographical cost of medical services in the specific zip code of the employees and dependents, modified by the other demographics of the employer group. Overall rates may be adjusted up or down each six months to allow for more accurate trending of the cost of medical services and avoid overly conservative long-term trend factors and double-digit rate increases at renewal.

Preferred Providers

The ISPACare™ Member Health program has contracts with over 20 National & Regional Preferred Provider networks. We also have the ability to contract with new networks - if you have a specific PPO network or physician/hospital group that you would like to see added to the PPO list that is currently contracted with the program, please contact us at 866-641-8854 with full details.

Pre-Certification/Case Management

Each participating employee has access to a toll free phone number that they may call 24 hours per day, 7 days per week for pre-certification of inpatient, outpatient, elective procedures, diagnostics, therapies, network guidance, and other needs. The benefit plan also includes large claim management services (case management) with a focus on facilitating more individualized and coordinated care for plan participants.

Claims Administrator

All claims administration services are provided or coordinated through MBA to increase administrative efficiencies and minimize costs. MBA adjudicates and processes all claims on behalf of the Plan.

Other Benefits

Optional dental and vision coverage is also available through the ISPA Group Benefit Trust. The ISPACare™ Member Health program quote may also include a selection of fully insured group life, accidental death and dismemberment coverage, and short and long-term disability coverage for ISPA members. Billing and claims services for these products are handled directly by the issuing carriers.