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  • For other than sole proprietors, payment of premium MUST be withdrawn from an employer sponsored account.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.