FAQs for Brokers and Employers

General FAQs

A. The SB/A Cooperative uses First Health Provider Network, one of the largest network of Hospitals, Clinics, and Physicians in the USA.

Remember, to utilize your benefit plan, verify your Providers and their facilities are contracted in your specific network.

Free Market Administrators (FMA) was created with over 100 years of experience health care at the Senior Executive Level. We are committed to creating value for our broad client base of both fully insured major medical and self-funded clients. FMA continues to be a critical measure for which we have maintained the highest performance standards within the industry. FMA remains focused on not only exceeding the highest ethical standards
in the industry, while upholding the utmost integrity for our clients, but also redefining the way our clients look at the world of health care benefits.

A. The Freedom Plans reside inside of the Small Business Agency Cooperative non-profit corporation. Secondly, there are coverage caps and by purchasing only the amount of care you might anticipate over the year, you can save a lot of money on your health care coverage.

A. Enrollees evaluate the plans and select a coverage limit or “cap”. This cap represents the upper limit of care provided. Supplemental  benefits or catastrophic plans may be added for additional coverage.

A. There are no waiting periods on basic level benefits or preventative care benefits. However, extended (enhanced) inpatient/outpatient benefits have a 90 day waiting period or 10 month waiting period depending on condition.

A. There are no front-end deductibles.

A. Yes, members will have access to 24 Hr. Virtual Clinic which allows members to call and speak to a state board certified physician who will be able to triage the patient and if required, prescribe appropriate medications to be picked up at a member pharmacy.

The SB/A Cooperative Medical Benefit plans may be enrolled anytime.

A member must be at least a business group of one – for example, a 1099 contractor, LLC, sole proprietorship, and must become a member of the SB/A Cooperative.

Spouses are eligible. Dependent children are eligible up to the age 26 (on their 26thbirthday they become ineligible), whether in or out of school, and regardless of whether they reside at home or not.

Yes. Must meet certain requirements depending on your state’s law.

Yes, they will receive their own medical ID card with name, specific plan information, and national PPO network. The card will also include the membership customer service number as well as provider information similar to most medical ID cards.

Brokers Employers

SB/A Cooperative FAQs

A. The SB/A CoOp 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 relationships for and between its members. The SB/A CoOp may legally aggregate small business employers together without becoming a Multiple Employer Welfare Association (MEWA) or acting as a Multiple Employer Trust (MET).

A. Business owner or Sponsor members pay $24 annually, which renews January 1 of each year.

A. The SB/A Cooperative sponsors a self-funded medical employee benefits program that is fully compliant with ERISA. ERISA supersedes the Affordable Care Act and grants an employer the ability to offer non-conforming ACA medical benefits that are more affordable, providing the employer meets specific ERISA mandated requirements – in writing, funding, and non-discriminating in-benefit levels and eligibility.

A. The SB/A Cooperative offers medical health benefit plans that also include the Minimum Essential Coverages (MEC) as was required under the original Affordable Care Act. This includes Preventative Care, Routine Well Care, Adult Preventative Services and Screenings, Woman Preventive Services and Screenings, Child Preventive Services and Screenings, and 100% of ACA Mandated Prescriptions such as birth control.

A. Zero deductibles, first dollar coverage, low out-of-pocket maximums, no pre-existing condition exclusions, no waiting periods*, Affordable Care Act Preventative (MEC- Minimum Essential Coverage) covered at 100%, pharmacy prescription, Virtual Clinic 24/7, dental and vision discount plan.

* Maternity Inpatient and Outpatient services are effective 10 months after the effective date of enrollment. Extended Inpatient and Outpatient Benefit Provision services are effective 90 days after effective date of enrollment.

A. Major Medical plans combine the everyday health care plan with a catastrophic plan, and usually include a high deductible that must be met. The SB/A CoOp is a non-profit corporation. Annual coverage limits for different plan choices further reduce premiums for Employers and Employees. Enrollees in any plan realize immediate savings from no deductibles with 50/50 coinsurance with first dollar coverage.

ERISA FAQs

A. The Employee Retirement Income Security Act of 1974 is a Federal law that sets minimum standards  for most voluntarily established retirement and health plans in private industry to provide protection to individuals In these plans.

A. ERISA sets the standards of conduct for those who manage an employee benefit plan and its assets (called fiduciaries). An ERISA-covered group health plan is an employment-based plan that provides coverage for medical care, including hospitalization, sickness, prescription drugs, vision, or dental.

A. COBRA, HRA’s, HSA’s, FSA’s (flexible savings accounts), 401k Plans, Pension Plans, Dental Insurance Plans, Vision Insurance Plans, Cooperatives, EAP’s (Employee Assistance Plans), Life Insurance Plans, Prepaid Legal Service Plans.