FAQs for Members / Employees

General FAQs

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

A. The Employer Freedom Plan utilizes the First Health PPO Network for medical services. First Health PPO is wholly owned by Aetna. Our belief is that the best network is not necessarily the one that has a slight discount advantage; it is one that:

  • 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

The Employer Freedom 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 Employer Freedom 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 (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. 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. If care is needed, call the plan administrator phone number provided on medical ID card. Verify coverage, pay at point-of-service and submit claim to plan administrator for adjudication and resultant reimbursement.

A. One factor is The Freedom 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, 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.

A. Careington Dental has been serving the dental community for over 20 years. Committed to making quality care more accessible and more affordable, Careington offers discount dental plans which offer continuous discounted services, without limits on use.

A. If you have questions about any features, benefits, and exclusions prior to enrolling, it is suggested you view the tutorial on the DACFreedomPlan.com website and click the Training Portal in the navigation bar.

If reviewed and still looking for answers, please call the SB/A CoOp Customer Service Representatives at (303) 566-0353.

Note: If you are already enrolled then you will call the plan administrator customer service number located on your medical ID card.