General FAQs

A. The SB/A CoOp uses First Health Provider Network, one of the largest network of Hospitals, Clinics, and Physicians in the USA.

Remember, to utilize your benefit plan, verify your Providers and their facilities are contracted in your specific network.

A. The SBA Freedom Protect Plan utilizes the First Health PPO Network for medical services. First Health PPO is wholly owned by Aetna. Our belief is that the best network is not necessarily the one that has a slight 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

The SBA Freedom Protect Plan utilizes ProCare Rx for prescription and pharmacy needs.

  • ProCare Rx is a full-service Pharmacy Benefit Manager (PBM)
  • Over 70,000+ pharmacies in the national network
  • Value based low net cost formulary with trends below national growth rates for the last 10 years
  • USA based customer service representatives 24/7/365

The SBA Freedom Protect Plan utilizes the Careington Discount Dental Plan. Careington is one of the most recognized professional dental networks in the nation. Careington works with 62,000+ participating dentists.

  • Save 20% to 60% on most dental procedures
  • Not insurance. Discount plans can be used continuously with no capped services.
  • Highly selective credentialing standards
  • Members may visit any participating dentist in the network at any time
  • Membership extends to all members of the family, throughout all 50 states

A. Free Market Administrators (FMA) was created with over 100 years of experience health care at the Senior Executive Level. We are committed to creating value for our broad client base of both fully insured major medical and self-funded clients. FMA continues to be a critical measure for which we have maintained the highest performance standards within the industry. FMA remains focused on not only exceeding the highest ethical standards in the industry, while upholding the utmost integrity for our clients, but also redefining the way our clients look at the world of health care benefits.

A. Free Market Administrators, your plan administrator, will provide you with a medical identification card (ID card) that will include important member and plan information.

As a member, you will present your Medical ID card to a health care provider and pharmacist as you would with any other health care coverage ID card. The provider will verify for membership eligibility and provide your service. The provider will process the claim directly with the plan administrator. Most of the time you will not pay anything at point of service. Some providers on some services may request  a portion of your share of the co-insurance.

If you are choosing to utilize your $20.00 co-payment benefit, remember to mention the co-payment for limited services at your provider.

If you are intending to use your Affordable Care Act (ACA) coverage, you must verify as such and that your provider will submit the proper CPT codes. Failure to do so will result in your billing submission to reflect your regular zero deductible 50/50 co-insurance amounts due.

Remember to verify your provider is in First Health network.

A. If care is needed, call the plan administrator phone number provided on medical ID card. Verify coverage, pay at point-of-service and submit claim to plan administrator for adjudication and resultant reimbursement.

A. One factor is The SBA Freedom Protect Plans reside inside of the Small Business Agency CoOp non-profit corporation. Secondly, there are coverage caps and by purchasing only the amount of care you might anticipate over the year, you can save a lot on your health care coverage.

A. Enrollees evaluate the plans and select a coverage limit or “cap”. This cap represents the upper limit of care provided. Supplemental  benefits or catastrophic plans may be added for additional coverage.

A. There are no waiting periods on basic level benefits or preventive care benefits. However, extended (enhanced) inpatient/outpatient benefits have a 90 day waiting period or 10 month waiting period depending on condition.

A. There are no front-end deductibles.

A. Yes, members will have access to 24 Hr. Virtual Clinic which allows members to call and speak to a state board certified physician who will be able to triage the patient and if required, prescribe appropriate medications to be picked up at a member pharmacy.

A. Careington Dental has been serving the dental community for over 20 years. Committed to making quality care more accessible and more affordable, Careington offers discount dental plans which offer continuous discounted services, without limits on use.

A. If you have questions about any features, benefits, and exclusions prior to enrolling, it is suggested you view the tutorial on the SBAFreedomProtect.com website and click the Training Portal in the navigation bar.

If reviewed and still looking for answers, please call the SB/A CoOp Customer Service Representatives at (303) 566-0353.

Note: If you are already enrolled then you will call the plan administrator customer service number located on your medical ID card.

The SB/A Cooperative Medical Benefit plans may be enrolled anytime.

A member must be at least a business group of one – for example, a 1099 contractor, LLC, sole proprietorship, and must become a member of the SB/A Cooperative.

Spouses are eligible. Dependent children are eligible up to the age (on their 26th birthday they become ineligible), whether in or out of school, and regardless of whether they reside at home or not.

Yes. Must meet certain requirements depending upon your state’s law.

Yes, they will receive their own medical ID card with name, specific plan information, and national PPO network. The card will also include the membership customer service number as well as provider information similar to most medical ID cards.

FAQ girl

SB/A CoOp FAQs

A. The SB/A CoOp is a Non-Profit Agency Cooperative Corporation that does not buy or sell products or services, but acts as the legal Collective Agent of all the Cooperative Members to facilitate advantageous relationships for and between its members. The SB/A CoOp may legally aggregate small business employers together without becoming a Multiple Employer Welfare Association (MEWA) or acting as a Multiple Employer Trust (MET).

A. Business owner members pay $24 annually or $2.00 per month.

A. The SBA Freedom Protect Plans utilize 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

ProCare Rx is the full-service Pharmacy Benefit Manager (PBM) and has a nationwide network of over 70,000-member pharmacies that includes major national and regional retail chains and independent pharmacies.

A. The base plans are called Plan A, B, C,  and D. As an everyday health care plan, employees will choose a plan with an annual coverage limit that meets their lifestyle and family needs.

A. Free Market Administrators (FMA) administers The SBA Freedom Protect Plans’ medical benefits on behalf of the SB/A Coop’s members. FMA is a Third-Party Administrator (TPA) headquartered in Addison, Texas. FMA serves employer clients with members in the lower 48 states. FMA 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.  FMA 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.

ProCare Rx administers The Freedom Plans’ pharmacy benefits. ProCare 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. ProCare Rx’s services, technology, and pharmaceutical pricing contracts are considered the be the best in the industry.

A. The SB/A CoOp sponsors a self-funded medical employee benefits program that is fully compliant with ERISA. ERISA supersedes the Affordable Care Act and grants an employer the ability to offer non-conforming ACA medical benefits that are more affordable, providing the employer meets specific ERISA mandated requirements – in writing, funding, and non-discriminating in-benefit levels and eligibility.

A. The SB/A CoOp offers its own SB/A Freedom Plan medical health benefit plans, and as an additional benefit, includes the ACA Minimum Essential Coverages as was required under the original Patient Protection and Affordable Care Act (ACA). This includes Routine Well Care, Adult Preventative Services and Screenings, Woman Preventative Services and Screenings, Child Preventative Services and Screenings, and 100% of ACA Mandated Prescriptions such as birth control.

A. Comprehensive health care plans include: zero deductibles, first dollar coverage, low out-of-pocket maximums, no pre-existing condition exclusions, no waiting periods for base plans, Affordable Care Act Preventative and Wellness Minimum Essential Coverage (MEC)  covered at 100%, pharmacy prescription, Virtual Clinic 24/7. Dental & vision discount plan may be included and are plan specific.

A. Major Medical plans combine the everyday health care plan with a catastrophic plan, and usually include a high premium plus a high deductible that must be met. The SB/A CoOp is a non-profit cooperativecorporation which reduces premiums, and the plans have annual coverage limits or “caps,” which further reduce the premiums, and offer zero deductibles with 50/50 coinsurance with first dollar coverage.

A. Extra Enhanced Inpatient and Outpatient Benefit Provisions are plan specific. The Extra Enhanced Inpatient Hospital and Outpatient Surgery Benefit Provisions are  subject to a 6/12 pre-existing condition provision – conditions which exist 12 months before the effective date will be excluded from coverage the first 6 months of coverage; maternity inpatient hospital and outpatient services are effective 10 months after the effective date. Emergencies excluded from waiting period.

A. An employer can include 1099 employees in their group plan. The only requirement is to include their premiums in the “list” billing from the plan administrator.

ERISA FAQs

A. The Employee Retirement Income Security Act of 1974 is a Federal law that sets minimum standards  for most voluntarily established retirement and health plans in private industry to provide protection to individuals in these plans.

A. ERISA was established by Congress and ERISA products are regulated by the Federal Government. The traditional insurance companies and their products are regulated by each of the 50 states through their individual departments of insurance.

ERISA sets the standards of conduct for those who manage an employee benefit plan and its assets (called fiduciaries). An ERISA-covered group health plan is an employment-based plan that provides coverage for medical care, including hospitalization, sickness, prescription drugs, vision, or dental.

The SB/A Freedom Plans are regulated under the Federal ERISA guidelines. These plans can be called health care plans or medical benefit plans.  Each of the 50 states has a separate insurance commission that regulates the major medical insurance plans. ERISA is restricted from using the “insurance plan” vernacular.

A. COBRA, HRA’s, HSA’s, FSA’s (flexible savings accounts), 401k Plans, Pension Plans, Dental Insurance Plans, Vision Insurance Plans, Cooperatives, EAP’s (Employee Assistance Plans), Life Insurance Plans, Prepaid Legal Service Plans.

SB/A CoOp FAQs

A. The SB/A CoOp is a Non-Profit Agency Cooperative Corporation that does not buy or sell products or services, but acts as the legal Collective Agent of all the Cooperative Members to facilitate advantageous relationships for and between its members. The SB/A CoOp may legally aggregate small business employers together without becoming a Multiple Employer Welfare Association (MEWA) or acting as a Multiple Employer Trust (MET).

A. Business owner members pay $24 annually or $2.00 per month.

A. The SBA Freedom Protect Plans utilize 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

ProCare Rx is the full-service Pharmacy Benefit Manager (PBM) and has a nationwide network of over 70,000-member pharmacies that includes major national and regional retail chains and independent pharmacies.

A. The base plans are called Plan A, B, C,  and D. As an everyday health care plan, employees will choose a plan with an annual coverage limit that meets their lifestyle and family needs.

A. Free Market Administrators (FMA) administers The SBA Freedom Protect Plans’ medical benefits on behalf of the SB/A Coop’s members. FMA is a Third-Party Administrator (TPA) headquartered in Addison, Texas. FMA serves employer clients with members in the lower 48 states. FMA 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.  FMA 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.

ProCare Rx administers The Freedom Plans’ pharmacy benefits. ProCare 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. ProCare Rx’s services, technology, and pharmaceutical pricing contracts are considered the be the best in the industry.

A. The SB/A CoOp sponsors a self-funded medical employee benefits program that is fully compliant with ERISA. ERISA supersedes the Affordable Care Act and grants an employer the ability to offer non-conforming ACA medical benefits that are more affordable, providing the employer meets specific ERISA mandated requirements – in writing, funding, and non-discriminating in-benefit levels and eligibility.

A. The SB/A CoOp offers its own SB/A Freedom Plan medical health benefit plans, and as an additional benefit, includes the ACA Minimum Essential Coverages as was required under the original Patient Protection and Affordable Care Act (ACA). This includes Routine Well Care, Adult Preventative Services and Screenings, Woman Preventative Services and Screenings, Child Preventative Services and Screenings, and 100% of ACA Mandated Prescriptions such as birth control.

A. Comprehensive health care plans include: zero deductibles, first dollar coverage, low out-of-pocket maximums, no pre-existing condition exclusions, no waiting periods for base plans, Affordable Care Act Preventative and Wellness Minimum Essential Coverage (MEC)  covered at 100%, pharmacy prescription, Virtual Clinic 24/7. Dental & vision discount plan may be included and are plan specific.

A. Major Medical plans combine the everyday health care plan with a catastrophic plan, and usually include a high premium plus a high deductible that must be met. The SB/A CoOp is a non-profit cooperativecorporation which reduces premiums, and the plans have annual coverage limits or “caps,” which further reduce the premiums, and offer zero deductibles with 50/50 coinsurance with first dollar coverage.

A. Extra Enhanced Inpatient and Outpatient Benefit Provisions are plan specific. The Extra Enhanced Inpatient Hospital and Outpatient Surgery Benefit Provisions are  subject to a 6/12 pre-existing condition provision – conditions which exist 12 months before the effective date will be excluded from coverage the first 6 months of coverage; maternity inpatient hospital and outpatient services are effective 10 months after the effective date. Emergencies excluded from waiting period.

A. An employer can include 1099 employees in their group plan. The only requirement is to include their premiums in the “list” billing from the plan administrator.

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