Employers know that offering health insurance is a key tool for retaining employees.  That’s especially important as the labor market picks up and employees have more work options.

BPA’s Limited Benefit Plan provides the limited health insurance coverage many workers need doctor visits, X-rays and lab work, prescription drugs, and limited hospitalization. 

BPA’s Limited Benefit Plan isn’t a major medical plan.  But for employees who have no health insurance, it can be important coverage.  Blue Cross and Blue Shield of Ohio recently released a study showing on average, 92% of their insureds use less than $1,000 of benefits per year (source www.theamericanworker.com). 

BPA’s Limited Benefit Plan is 100% self insured.  BPA can suggest appropriate premiums that will be 30%-50% less than a traditional major medical benefit.

All plans have the option of:

First dollar coverage
Assignable benefits
No medical underwriting (Guarantee Issue)
No pre-existing condition limitations
No benefit waiting periods
No networks for the medical benefits
No deductibles or co-insurance requirements
No coordination of benefits
Flexibility in plan design
Plan year benefit maximums ranging from $5,000-$25,000.

Plan designs feature coverage for:

Doctor Office Visits
Diagnostic, X-Ray, & Lab Work
Wellness Exams
Accidents
Hospital Stays
Prescription Drugs

We combine all of these features into unique and simplified enrollment and administration processes, allowing our clients to provide quality benefits to their employees.

Advantages of the BPA Limited Benefit Plan

• Guarantee Issue
• No Pre-existing Condition Clauses (No evidence of insurability required)
• Benefits are Assignable
• No Waiting Periods
• No Questionnaires to be filled out 
• Provider of Choice - No mandatory network usage
• Maternity Covered Same as any other illness
• No Coordination of Benefits
• Universal Rates - No demographics used
• Assignment of Benefits for Providers and Hospitals – No Claim forms
• Dedicated Account Representatives
 

Employer Advantages

• Cost is 25%-50% less than typical catastrophic insured plan.                   
• Employer defines eligibility and covered benefits.
• Employer Can Contribute or decide not to contribute.                               
• Can be used in a dual plan with other plan having catastrophic benefits. 
• No carrier requirement for minimum participation.                                                        
• Employer could only choose to contribute to lower cost plan.                                                                                            
• Offer the limited benefit plan to only dependents and spouses.

Eligible Participants

• Part-time, seasonal, and hourly employees are eligible
• 1099 Independent Contractors are eligible
• Employees, dependents, and spouses

 Available Coverages

• Office Visits
• Wellness/Preventative Care Benefits
• Prescription Drugs, Including $5 Generic Copay
• Diagnostic Lab & X-Ray
• Surgical Benefits
• Hospital Inpatient Benefits
• Intensive Care Benefits
• Substance Abuse Benefits
• Skilled Nursing Benefits
• Mental Illness Benefits
• Life Insurance and AD&D
• Dependent Life
• Employee Disability Weekly Benefit
• Accident Benefit
• Vision Care Benefit
• Dental Care Benefit
• Pharmacy Programs
 

 Limited Benefit Plan

Fee Schedule

Administration	Rate
Medical Claims	$15.00 PEPM
Dental Claims	$2.00 PEPM
Broker Fee	$5.00 PEPM
Standard Data Analysis and Reporting	Included
COBRA/HIPAA/Government Compliance	$2.50 PEPM
Managed Care Programs
Alliance	$6.50 PEPM
Utilization Management In-Patient Utilization review	$2.00 PEPM

Implementation & Set Up
Implementation Fee	$2,000 (one-time)
Plan Document	Included
Booklets/printing	Cost
Internet Access-24 Hour claim info	Included
On-line services- Direct Access for Eligibility	Included

Projected Monthly Premium Cost $10,000 maximum yearly benefit	Claims +Admin=Projected Premium
Single	$151.04 +$33 = $184.04
Employee + Spouse	$309.64 +$33  = $342.64
Employee + Child	$271.66 +$33  = $304.66
Family	$483.34 +$33  = $516.34

PEPM-Per Employer Per Month

The above premiums are not underwritten and actual claim cost may be above the premium.  Premium is illustrative only.

10/27/2005