What to Expect
Minimum Value Plans (MVP) Satisfy ACA Parts A and B
Click on the plans below to see the summary of benefits for each. We’re confident you’ll find at least one plan that will meet your unique needs.
Swipe to the right to see the full table.
INN – In-Network | OON – Out-of-Network PHCS Physician Network (Base funding rates effective 01/01/2023) Unlmited | MVP Basic Limited Day Medical℠ Plan |
|---|---|
Single | $402.30 |
Employee & Spouse | $653.57 |
Employee & Child(ren) | $575.31 |
Family | $826.59 |
ACA Preventive and Wellness Covered 100% | Covered 100% |
Deductibles (INN|OON) $5,000/$10,000 | None |
Max Out-of-Pocket (IND/FAM)
(excludes non-covered days/services) | $8.700 /$17,400 |
Physician Services | |
Telehealth | $0 Copay (Unlimited) |
Primary Care Office Visits (INN|OON) | $25 Copay 8 Visits Max/Year INN – PHCS Rate | OON – 85% UCR |
Specialty Care Office Visits (INN|OON) | $50 Copay 8 Visits Max/Year INN – PHCS Rate | OON – 85% UCR |
Urgent Care (INN|OON) | $50 Copay 2 Visits Max/Year INN – PHCS Rate | OON – 85% UCR |
Out-Patient Services | |
Non-Hospital Based Lab/X-Ray Services
(INN|OON) | $50 Copay 3 Visits Max/Year INN – PHCS Rate | OON – 85% UCR |
Out-Patient Surgery/Complex Imaging (RBP*) | $350 Copay per Visit 1/1 Visit Max/Year |
Hospital Services | |
In-Patient Hospital (RBP*) | $350 Copay per Admission 5 Days Max/Year |
Emergency Room (RBP*) | $350 Copay 1 Visit Max/Year |
Pharmacy Benefits | |
Generic Rx Preventive | $0 Copay |
Generic Rx: Tier 1 (Prev) | Tier 2 (non-Prev) | Tier 1 – $5 Copay | Tier 2 – Not Covered |
Brand Rx: Tier 3 (Preferred) | Tier 4 (Non-Pref) | Not Covered |
Specialty Rx | Not Covered |
See if Your Practice Qualifies
Use the “Apply Now” link below to see if your practice qualifies. This brief 2-page form will help us better understand the needs of your practice. You will be notified within 48 hours whether or not your practice is approved.
Complete Your Paperwork
Frequently Asked Questions
WHO IS THE CARRIER?
The HBA program is a unique, level-funded, self-insured program in which each employer is its own Plan Sponsor and Plan Administrator as defined within ERISA and is free to pursue the claims funding/reinsurance strategy of its own choosing. While the HBA is not a traditional insurance carrier and does not participate in or facilitate any transaction of insurance, employer inquiries will be referred to appropriate, informed parties for appropriate action to protect employer interests.
WHAT ARE THE UNDERWRITING REQUIREMENTS?
Must have at least 2 W2 employees, employer must complete group questionnaire.
WHAT NETWORK ARE WE USING?
The largest network nationwide, the PHCS Network.
HOW DO I GET A QUOTE?
Fill out the employer health questionnaire above, you will hear back within 48 hours whether or not your group qualifies.
HOW DOES BILLING WORK?
Invoices are sent electronically directly from HBA administrators between the 7th-12th of every month. Premiums are collected via ACH on the first business day of the following month.
IS THERE A MINIMUM PARTICIPATION REQUIREMENT FOR THE PLAN TO BE WRITTEN?
Depending on the plans offered, the HBA program requires participation of 25-50% of eligible employees who are not covered as a dependent under another group health plan.
HOW MUCH DOES THE EMPLOYER HAVE TO PAY TOWARDS THE EMPLOYEE’S COVERAGE?
The employer must contribute at least 50% of the employer only cost.
WHO HANDLES COBRA FOR THIS PLAN?
HBA administrators will provide COBRA administration services for all groups.
HOW ARE ENROLLMENTS DONE?
They will be done electronically online.
WILL THIS INTERFERE WITH MY PAYROLL SYSTEM?
No, in many cases it can integrate with the payroll system.
CAN ADDITIONAL BENEFITS BE OFFERED THROUGH THE PROPS CENTER HEALTH PLAN?
Yes, Vision, Dental, and Life benefits can be added to supplement medical coverage.
WHAT IF OUR GROUP DOESN'T QUALIFY?
If your group doesn’t qualify we will work to find you a plan that will suit your needs.