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AN AFFORDABLE ACA QUALIFIED AND ERISA COMPLIANT HEALTH PLAN SOLUTION

FREEDOM SELECT PLANS

 

 

Plans A, B, and B250 Includes Minimum Essential Coverage plus Preventive Care Benefits Maximizing savings and providing cutting-edge solutions to help you effectively manage your health care cost

Free Market Administrators, LLC (FMA) is a Third Party Administrator headquartered in Addison, Texas.

 

  • FMA was created with over 100 years of experience in health care at the Senior Executive Level.

 

  • FMA is committed to creating value for our broad client base of both fully insured, major medical, and self-funded clients. 

Sponsored by: SB/A Cooperative Administered by: Free Market Administrators, LL

FMA remains focused on not only exceeding the highest ethical standards and upholding the utmost integrity for our clients, but also redefining the way our clients look at the world of health care benefits.

• FMA has over 40,000 members

• FMA works with all major leasable PPO networks plus access to Reference Based Pricing

Partners of FMA Freedom Select Plans

SB/A CoOp

The SB/A Co-Op 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 contractual relationships for and between the members. The SB/A Co-Op may legally “aggregate” small employers

together without becoming a Multiple Employer Welfare Association (MEWA) or acting as a Multiple Employer Trust (MET). The SBA Co-Op sponsors the unique ERISA Employer Healthcare Benefits Plans that are ACA qualified when attached to ACA Minimum Essential Coverage.

Serve You Rx

 

Since 1987, Serve You Rx has been the pharmacy benefit manager (PBM) of choice for employee benefit brokers and consultants, their clients, including employers, unions, coalitions, and governmental entities, as well as third party administrators who are looking for a valuable partner to effectively manage prescription drug costs. Serve You Rx offers:

 

• Stability

• Consistency

• Flexibility

• Customized plan designs

• Consultative clinical support • Robust trend management programs and strategies

• Exceptionally focused member and client service

• Quality-driven, Serve You Rx owned and operated mail service and specialty pharmacies

• Over 66,000 pharmacies nationwide

• Privately owned and headquartered in Milwaukee, Wisconsin

• Wholly-owned mail order pharmacy

The SB/A Cooperative Efficiency | Savings | Simplicity | Freedom

The SB/A CoOp was formed in 2017 as a Non-Profit “Agency” Cooperative Corporation to provide for employer/employee health care benefits in the small and large group employer marketplace. Each group employer CoOp Member can sponsor a Self-Funded ERISA Employer Welfare Benefit Plan for the benefit of its employees and their dependents. Called the “SB/A Cooperative Sponsored Freedom Plan,” it is an ERISA health plan for sponsoring employers offered in conjunction

with Preventive Care Benefits. The employer’s claim exposure is protected via an “Aggregate Stop Loss Fund (ASLF).”

 

Each SB/A CoOp Employer Member has its own SB/A Cooperative Sponsored Freedom Plan funded claim account administered by Free Market Administrators, the Plan Administrator. The employer’s maximum claim liability is limited to the 12-month level funding of its claim account.

To participate and take advantage of the SB/A Freedom Plans options, the following is required:

 

1. Broker and Employers must join the SB/A CoOp – complete the SB/A CoOp Membership Agreement and pay the annual $24 membership fee ($2.00/ month).

 

2.Broker completes the SB/A CoOp Compensation form, Broker W-9, and Broker Information Form – this is a one-time requirement.

 

3. Employer completes the Group Information Form.

 

4. Employees complete the SB/A Sponsored Freedom Plan Employee Enrollment Form. For larger employer groups, Employers can submit an electronic eligibility spreadsheet

The purpose for which the SB/A CoOp is organized is to foster the development of Partially Self-Funded healthcare benefit arrangements which include the use of Level Funded ERISA compliant “Limited Benefit Plans,” the use of Employer funded “Aggregate Stop Loss” coverage and reinsurance consistent with applicable state and federal laws, including ERISA.

 

To act primarily as the legal agent for all the Cooperative Members in arranging for and facilitating ERISA compliant and ACA qualified employer/ employee health benefit plans that are administered by a legal Third Party Administrator (TPA).

 

Brokers/Agents that are members of SBA CoOp and who are compensated by SB/A CoOp, market the SB/A CoOp and “The SB/A Freedom Plans.”

To participate and take advantage of the SB/A Freedom Plans options, the following is required:

 

1. Broker and Employers must join the SB/A CoOp – complete the SB/A CoOp Membership Agreement and pay the annual $24 membership fee ($2.00/ month).

 

2.Broker completes the SB/A CoOp Compensation form, Broker W-9, and Broker Information Form – this is a one-time requirement.

 

3. Employer completes the Group Information Form.

 

4. Employees complete the SB/A Sponsored Freedom Plan Employee Enrollment Form. For larger employer groups, Employers can submit an electronic eligibility spreadsheet

The purpose for which the SB/A CoOp is organized is to foster the development of Partially Self-Funded healthcare benefit arrangements which include the use of Level Funded ERISA compliant “Limited Benefit Plans,” the use of Employer funded “Aggregate Stop Loss” coverage and reinsurance consistent with applicable state and federal laws, including ERISA.

 

To act primarily as the legal agent for all the Cooperative Members in arranging for and facilitating ERISA compliant and ACA qualified employer/ employee health benefit plans that are administered by a legal Third Party Administrator (TPA).

 

Brokers/Agents that are members of SBA CoOp and who are compensated by SB/A CoOp, market the SB/A CoOp and “The SB/A Freedom Plans.”

The SB/A Cooperative Efficiency | Savings | Simplicity | Freedom

FMA Freedom Select Plan B250 $250,000 / $500,000 Catastrophic FAQs

Q. Are pre-existing conditions eligible for benefits on the Catastrophic program?

A. If an employee enrolls with a medical condition that would be considered a pre-existing condition, it will not be covered for the first 12 months from the program effective date.

 

For example, if a person was treated for a heart condition in the 12 months prior to the program effective date, that would be considered a pre-existing condition.

 

The program would not cover expenses for any services or treatments related to that person’s heart condition for the first 12 months the employee is enrolled into the program.

Q. If an employee has a large family, are they eligible for the Catastrophic program?

A. Yes, families of any size are eligible.

Q. Does this program use a specific network?

A. No, medical expenses are paid directly to the hospital at referenced-based pricing reimbursement levels.

Q. Does Catastrophic allow inpatient hospital-based medical expenses?

 

A. The plan will allow the following inpatient hospital-based medical expenses for employees of this enhanced benefit level:

• Inpatient surgery (excludes elective surgeries)

• Hospital stays for inpatient substance abuse and mental health

Q. If Employees move to another state, will they be able to continue in the Catastrophic program?

 

A. Yes, employees will continue in their benefit program if they move to another state. Note: The program is not available outside the United States and may not be used while traveling or relocating outside the United States.

 

Q. Are Employees allowed to make changes to their Catastrophic program?

 

A. Employees may only make changes to their program on their Annual Enrollment Date or if they experience a Qualified Event.

 

A Qualified Event is one of the following:

• Change in legal marital status – marriage, divorce, annulment, death of a spouse or legal separation

• Change in dependent children – birth, adoption, legal guardianship, or death of a child

• Loss of spousal coverage – loss of job, etc.

• Dependent children “age out” – child’s age exceeds the age limitations of the membership

 

Q. What happens when an employee turns 65 years old?

 

A. Their benefits will be termed at midnight on the day of their 65th birthday.

• Preventative Care, Wellness Visits, Pap Smears, Flu Shots, Immunizations, and more

• Primary Care, Specialist, and Urgent Care Visits Plus X-rays, CT and MRI Scans, Lab and Diagnostic Services • Prescription Drugs – ACA at 100% (includes Birth Control), plus all others at indicated co-insurance up to threshold limit using the Serve You Rx pharmacy card at your favorite pharmacy

• Inpatient/Outpatient Behavioral Health Care benefits limited to 30 days

• Pharmacy benefits are eligible for Rx discounts above base plan threshold

• Pharmacy prescription coverage is limited to $500 per prescription per month

• Employee must be actively at work, not be hospitalized, and not be out on a Workman’s Comp claim for their coverage to be effective on their initial effective date • Out-of-network provider charges will be subject to negotiated reimbursement and covered member may be subject to balance billing by the provider

• Certificates of coverage cannot be changed for 12 months from effective date except as regulated by law • No Medical Underwriting is required

• No Pre-Existing Condition clauses apply to Plan A

• Pre-Existing Condition clauses apply to Plan B and Plan B250.

• Pre-Existing Conditions - A Pre-Existing condition is any medical condition for which you experience signs, symptoms, testing, treatment or take medication for, before enrolling.

 

Any condition(s), as defined above, that was present 12-months prior to the policy effective date will be considered pre-existing condition(s) and ineligible for coverage during a period of 12-months from the policy effective date. Primary Care, Urgent Care, and Preventative visits, and Non-Specialty Prescriptions are not subject to the pre-existing condition(s).

 

• No Waiting Periods apply to Basic Benefit provisions • All medical claims over $5,000 are subject to claims auditor review for medical necessity, permissibility, and appropriateness of charges.

• Plans A and B are available to employer groups with 3 or more enrolled.

• Plan B250 is available to employer groups with 5 or more enrolled.

• Patient is eligible for “Contractual Discounts” in excess of Annual Maximum benefits as “Patient Pay Responsibility.”

• Maternity inpatient hospital and outpatient services are effective 10 months after the effective date

Plan Provisions and Exclusions

Exclusions from coverage:

• Any hospital confinement that began on or before the effective date is excluded from plan coverage

• Workers Compensation injuries and illness

• Cosmetic surgery procedures – exceptions to some reconstructive surgeries

• Bariatric/Gastric Sleeve surgery

• Sex transformation / change surgery

Medical Staff
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