Group Post Age-65 Retiree Medical Solutions
The Health Benefit Alliance includes a nationwide leader in the design, installation, and administration of Group Sponsored post-65 retiree Medical and Pharmacy Benefits. They are an Employee-owned business (ESOP) that is also a federally qualified Women-Owned Small Business Entity (WBE and WOSB). They are licensed to conduct business in 49 states as well as DC and PR as a Third Party Administrator (TPA). Our Health Alliance partner currently provides retiree benefit plan administration and related services for more than 1,600 plan sponsors throughout the US representing nearly 400,000 retirees and administers more than $500 million in retiree benefit premiums annually.
As stated previously, The Health Benefit Alliance Mission is a coalition of industry leaders and innovators. As such, our Group Retiree partner has consistently been recognized and awarded for excellence. They have recently performed and successfully completed a SAS 70 Type II audit with Price Waterhouse Coopers and in 2019 they will conduct a SOC Type I and II accreditation. This is in addition to the audits that are conducted at least annually by their national carrier partners which include The Hartford, United American, Transamerica, Aetna, Anthem, Express Scripts, Inc. and others.
They are specifically focused on the administration of retiree medical and prescription drug plans. They work with brokers and consultants to provide retiree medical and prescription drug solutions nationwide for companies and organizations including:
- Publicly and Privately-held Companies
- Labor Unions
- City and County Government Entities
- Educational Organizations Religious Organizations
Through this partnership with The Health Benefit Alliance, members can have access to plans that are rich and benefits as well as help retirees save money. All of the group retiree medical plans help pay for the costs recognized but not covered by Medicare Parts A and B.
- No Networks: Our plans provide access to all Medicare providers nationwide. Therefore, retirees have the freedom to choose their own doctors.
- Coverage is not limited to a local area.
- No Referrals: Retirees can see specialists when they choose.
- Guaranteed Issue: There are no pre-existing condition exclusions.
- Spousal coverage is available when the spouse is over 65 and enrolled in Medicare Parts A & B.
- Portability: Coverage can go with retirees if they move or have multiple residences.
- Affordable: Our plans offer competitive, fully-insured rates to limit financial risk.
- Electronic Claims: Claims are processed through Medicare’s crossover process. There is virtually no retiree claim forms.
The Health Benefit Alliance Group Retiree partner has created one of the most innovative and cost-effective Employer Group Waiver Plans (EGWP), established for groups under Medicare Part D, in the nation. Employers contract with the Centers for Medicaid and Medicare Services (CMS) to serve as a Medicare Part D Plan Sponsor. The plan manages compliance with CMS regulations regarding Part D plans.
- Plan designs are available that fill the Medicare Part D Coverage Gap, commonly referred to as the “donut hole”.
- Plans can cover brand drugs and generics in the coverage gap, or just generics, based on the group’s desired plan design.
- The Medicare National Preferred Formulary includes coverage for all drugs eligible under Medicare Part D.
- Over 66,000 pharmacies nationwide are included. The closest 10 locations are included with each retiree’s ID card.
- Retirees can receive a 90-day supply of most medications, typically with lower co-pays than they would pay at retail.
Additionally, the plan premium rates include the Medicare Part D subsidy. There is no additional subsidy filing needed, industry studies report that the average subsidy under their EGWP plans is higher than the average subsidy received by their clients who file for the RDS subsidy.