Association Self-Funded
Association Self-Funded coverage is setup like Commercial Self-Funded coverage but instead of an employer directly funding their own claims, you join and become part of a bargaining union, as members pay into a common health fund. The premiums are therefore based on the expected claims costs for the enrollment of everyone within the health fund, not just your own employees.
Advantages
- PPO national network so you can see doctors who only accept out-of-network coverage for your network.
- Not being subject to state mandates; i.e. less underwriting regulation usually means lower premiums.
- Health Status WON'T Affect Premium Rates
Disadvantages
- Medical Underwriting is required
- Extra fees for Union participation
- Unlike Commercially Self-Insured, Low-Claims utilizers won't get money back
- ID#'s are difficult to obtain before cards arrive.
What You Need to Know
Phone #'s-
1) Problems with Claims or Billing- Cook Associates- Third Party Admin.- #646-381-8851.
NOTE: Do Not Call Cigna or UnitedHealthcare for this!
2) Problems with Proof of Coverage- Union- #516-741-5564
Payment Method-
Required:
- Bank Account #
- Routing #
- Voided Check
Note: Request for Paper Invoice is an extra $20/month
Association Fee-
- Upon enrollment, an added $125 processing fee is included and $20/month for participating.
Eligibility-
- Must be an Employer Sponsored Plan or Sole Proprietorship. Employer Group Size doesn't apply.
- You must join the Premier Association
- For Employer Sponsored Plans- Full-Time Employees Only may apply for coverage
Who is a full-time employee?-
- Full-time employees work 30 hours per week for at least 120 days in the calendar year
Occupational Eligibility-
Industry Status is required for coverage
Call or Email Us for Industry Eligibility Page.
FTE Inclusion-
Doesn't apply- N/A
FTE Calculation-
Doesn't apply- N/A
Employer Contribution-
- For other than sole proprietors, payment of premium MUST be withdrawn from an employer sponsored account.
Participation-
Doesn't apply- N/A
Deadlines-
13th or 15th of the month depending on the Association health plan for a subsequent 1st effective date.