FAQs for Brokers and Employers

A. The Employer Plans utilize the PHCS preferred provider network, one of the largest national networks of hospitals, clinics, and physicians in the USA. Out of Network providers are reimbursed at different levels of percentage of U&C or Medicare.

A. There are no waiting periods on all SB/A Freedom Plans Basic Level benefit plans (Plans A, B, C).  The Extra Enhanced Benefit provisions on Plan C contains a 60-day waiting period for elective procedures, a 6-month waiting period for conditions treated within 12 months before the effective date, and 10 months waiting period for maternity.

A. No. Coverage is subject to coinsurance up to the out-of-pocket maximum.

A. Dependent children are eligible up to their 26th birthday whether in or out of school. Common law marriages are allowed if certain requirements are met under individual state laws.  Married couples cannot split their enrollment into two enrollees.

A. SB/A CoOp sponsored health care plans are fully compliant and qualified with the Affordable Care Act and include the provisions of minimum essential coverage (MEC).

A. Employers are not required to contribute under the regulations of ERISA. However, the attraction and retention of talented and valuable employees should be evaluated when determining contribution amounts.

A. Yes – the SB/A CoOp sponsored health care plans are subject to ERISA and are available in all 50 states and US territories.  The Employee Retirement Income Security Act of 1974 (ERISA) is a Federal law that sets the minimum standards for most voluntary retirement and health care plans in private industry to provide protection to individuals in these plans.

A. The SB/A Cooperative is a member-based organization that facilitates self-funded employer health care programs for its members. Employers and Broker Agents must join the SB/A CoOp and pay the annual fee.

Girl at computer