FAQs for Brokers and Employers

General FAQs

A. The SB/A CoOp uses the PHCS Network.

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

A. The SB/A Freedom Protect Plan utilizes the First Health PPO Network for medical services. First Health PPO is wholly owned by Aetna.

  • Offers extensive patient access to network providers
  • Offers competitive or lowest actual dollar pricing – not stated discounts
  • Excludes or minimizes contract language default pricing
  • Utilizes best in class providers based on treatment outcomes

Telehealth: 24 Hr Virtual Clinic allows you to reach a US licensed board certified physician.

  • Physicians will triage the patient, diagnose, and offer a personalized treatment plan
  • Physicians can prescribe medications which can be purchased at a member pharmacy

The SB/A Freedom Protect Plan utilizes ProCare Rx for prescription and pharmacy needs.

  • ProCare Rx is a full-service Pharmacy Benefit Manager (PBM)
  • Over 70,000+ pharmacies in the national network
  • Value based low net cost formulary with trends below national growth rates for the last 10 years
  • USA based customer service representatives 24/7/365

The SB/A Freedom Protect Plan utilizes the Careington Discount Dental Plan. Careington is one of the most recognized professional dental networks in the nation. Careington works with 62,000+ participating dentists.

  • Save 20% to 60% on most dental procedures
  • Not insurance. Discount plans can be used continuously with no capped services.
  • Highly selective credentialing standards
  • Members may visit any participating dentist in the network at any time
  • Membership extends to all members of the family, throughout all 50 states

A. Free Market Administrators, your plan administrator, will provide you with a medical identification card (ID card) that will include important member and plan information.

As a member, you will present your Medical ID card to a health care provider and pharmacist as you would with any other health care coverage ID card. The provider will verify for membership eligibility and provide your service. The provider will process the claim directly with the plan administrator. Most of the time you will not pay anything at point of service. Some providers on some services may request  a portion of your share of the co-insurance.

If you are choosing to utilize your $20.00 co-payment benefit, remember to mention the co-payment for limited services at your provider.

If you are intending to use your Affordable Care Act (ACA) coverage, you must verify as such and that your provider will submit the proper CPT codes. Failure to do so will result in your billing submission to reflect your regular zero deductible 50/50 co-insurance amounts due.

Remember to verify your provider is in First Health network.

A. 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. One factor is The SB/A Freedom Protect Plans reside inside of the Small Business Agency CoOp 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 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 preventive care benefits. However, extra enhanced inpatient/outpatient benefits have a 90 day waiting period or 10 month waiting period for maternity.

A. There are no front-end deductibles.

A. Yes, members will have access to 24hr 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.

A. Careington International Corporation is one of the most recognized professional dental networks in the nation and boasts one of the largest dental networks nationally with a focus on neighborhood dentists. Careington networks are a leader in member-transparent pricing with robust fee schedules. 

Careington Dental Plan Features: 

  • Save 20% to 50% on most dental procedures including routine oral exams, unlimited cleanings, and major work such as dentures, root canals, and crowns 
  • 20% savings on orthodontics including braces and retainers for children and adults 
  • 20% reduction on specialist’s normal fees. Specialties include: Endodontics, Oral Surgery, Pediatric Dentistry, Periodontics, and Prosthodontics where available 
  • Cosmetic dentistry such as bonding and veneers also included 
  • All dentists must meet highly selective credentialing standards based on education, background, license standing and other requirements 
  • You may visit any participating dentist on the plan and change providers at any time 

How to Access the Discount: 

Step 1: To locate a participating provider, please call (800) 290-0523 or visit www.careington.com to access the online provider search. 

Step 2: When scheduling an appointment, please inform the participating provider’s office you are a member of the Careington Dental Network. 

Step 3: Please present your Careington ID card upon arrival to receive savings. 

Step 4: The provider will collect payment at the time of service. You are responsible for paying the total bill, less the applicable savings, when service is provided.