Elite PPO Health Insurance

[scagnt83]

and can be declined which a true ERISA plan can not do......

Im not saying this particular plan is legit. But asking health questions does not necessarily mean they can be declined. ERISA Health Plans can Rate based on Expected Claims. Which means they can ask health questions to help determine the premium.

 

[STIBROKER]

Im not saying this particular plan is legit. But asking health questions does not necessarily mean they can be declined. ERISA Health Plans can Rate based on Expected Claims. Which means they can ask health questions to help determine the premium.

Yes they do.....they question all the employees to set the risk of the group.....so the more healthy and young the better the rate.....but this is not a Group ERISA plan.......

 

[leevena]

I offer this plan to selected clients (I have 7 enrolled to date), so far it has worked well. It's a NY union that exists solely to offer health insurance, regardless of what anyone claims about it being a 'scam' it's been doing this for a long time.

Premiums for the Silver copay for 2017 are $548 per month for an individual, $1022 for couple, $1298 for family.

I've done my due diligence and am satisfied (reviewed multiple annual Form 5500s) as to the viability. There isn't a link to the documents but you can search here: https://www.efast.dol.gov/portal/app/disseminatePublic?execution=e2s2# and use 'International Brotherhood of Trade' in the Sponsor name. They paid out $19M in claims in the last claim year (from the Form 5500, Auditor's Statement):

LOCINTERNATIONAL BROTHERHOOD OF TRADE UNIONS LOCAL 713 HEALTH AND WELFARE FUND
STATEMENTS OF CHANGES IN PLAN BENEFIT OBLIGATIONS
2015 2014
Amounts Currently Payable to or for Participants, Beneficiaries, and Dependents, and Premiums Due to Insurers
Balance at Beginning of Year $ 906,300 $ 5 54,100
Claims Reported and Approved for Payment 19,508,710 7,249,474
Claims Paid (18,670,310) (6,897,274)
Plan's Total Benefit Obligations at End of Year $ 1 ,744,700 $ 906,300

Everyone should make up their own minds about offering this as an alternative to ACA Off Exchange plans-it is fully compliant and uses the Cigna OAP PPO network nationally.

Don't take my word for it or anyone elses, do your due diligence and make your own decision if you think your clients need more options for 2018 and future years.

Viewing the 5500 form is useless and does not provide anywhere near the information needed to validate a plans worthiness.

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This plan falls under ERISA for the simple reason that they file an annual Form 5500 and have been doing it for a long time.

They also have a TPA that administers claims (Cook and Associates in New York) and a re-insurance agreement for catastrophic claims.

I have no vested interest in other agents using this or not, just sharing my experience with this specific plan.

Just because a sponsor files a 5500 form does not necessarily mean the state is not involved.

Just because there is a reinsurance contract does not automatically mean the plan is safe.

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Yes......and they need a contract with a real insurance company to administrate the claims and to re insure if the fund run's dry there is someone to pay claims....I got roped into a deal like this with Employers Mutual scam and they were also playing the ERISA card.... I had to testify for the Texas DOI and pay a fine to keep my Lic.......the day of the trial James invited me to dinner that night.... had decline because I trully thought I would have been whacked.....
Fraudster sentenced for health insurance scam | Business Insurance

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If you read this it talks about employer's......a business with employees......not members of a association.....which are not employees.....and a true ERISA group plan can not deny anyone......is this plan guaranteed issue.....

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False. An ERISA plan can deny coverage.

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A warning for anyone reading this post, or any other on this forum. You should be aware that there is no one qualifying the statements made. I am constantly surprised by posts that are clearly erroneous, even though the writer may come across confidently. Some posts may even be well intentioned, and the writer simply made an honest mistake.

 

[STIBROKER]

False. An ERISA plan can deny coverage.

Are you sure about that ....I am talking about a True Group Self funded plan.....

https://www.tdi.texas.gov/pubs/consumer/cb108.html





.

 

[leevena]

Are you sure about that ....I am talking about a True Group Self funded plan.....

https://www.tdi.texas.gov/pubs/consumer/cb108.html





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Self funded plans can, and often do, deny coverage for a variety of conditions, services, even drugs. They can also refuse coverage to any group.

Read the link twice, cannot find anything. Can you be more specific?

ERISA plans are essentially any welfare plan offered, such as medical, disability, etc. Even fully insured medical are subject to some level of ERISA.

 

[STIBROKER]

Self funded plans can, and often do, deny coverage

Then show that to me in writing....all I am coming up with is Employers opting to put in a Self funded plan for employees which we all know can not be declined for group coverage ....now these Self Funded Association/Union plans are all smoke and mirrors.....They do not employ anyone or pay employment taxes on them.....

 

[leevena]

Then show that to me in writing....all I am coming up with is Employers opting to put in a Self funded plan for employees which we all know can not be declined for group coverage ....now these Self Funded Association/Union plans are all smoke and mirrors.....They do not employ anyone or pay employment taxes on them.....

Calm down skippy, you are all over the board and I cannot understand what you are trying to say with this post. If you believe that a self-funded plan cannot decline to offer coverage to an employer, go with it. If you believe that self-funded plans are smoke and mirrors, go with it. I am not trying to convince you otherwise. The last sentence about employment and taxes is confusing.

Save the anger for someone else.

 

[STIBROKER]

The last sentence about employment and taxes is confusing.

simple.....Guaranteed Health Insurance can only be obtained one of 2 ways.....through the ACA......or through a group plan...... to get into a group plan one has to be an employee of the company instituting the group plan and the company has to pay employment taxes as in a W2 to get a group health plan in place.....or 1099 employee if there are at least 1 to 2 W2 employees on the group plan......at any rate the employee has to be paid by the company...do not see why you find this confusing.......

 

[BarryDaisy]

Where can I find brochures or info about company?

 

[STIBROKER]

Where can I find brochures or info about company?

Here you go........