Introducing
**NOT AVAILABLE FOR SALE IN:
Hawaii, Washington, Oregon, California, Minnesota, New Hampshire or Vermont**
Breeze FMO is excited to offer America's Choice, a premier provider of comprehensive health insurance solutions, now available for contracting to agents. America's Choice is designed specifically for self-employed individuals, gig workers, and 1099 contractors across the United States.
Choose a Plan Network: Clients can choose from the Blue Cross Blue Shield PPO Network or the PHCS Practitioner & Ancillary Network
Tailored Coverage: Plans are specifically tailored to meet the unique needs of individuals working outside traditional employment structures.
Comprehensive Benefits: Coverage includes preventive care, medical emergencies, prescription medications, and specialist consultations.
Affordability and Accessibility: America's Choice emphasizes affordability, ensuring policyholders receive necessary care without undue financial burden.
High-Quality Care: Committed to delivering high-quality care and exceptional service.
Innovative Programs: Dedicated to improving health and well-being through innovative programs and extensive provider networks.
Customer-Centric Approach: Focuses on providing exceptional service and support to policyholders.
America's Choice is dedicated to enhancing the health and well-being of its members, making it a valuable addition to your portfolio. Join us in offering this exceptional health insurance solution and provide your clients with the coverage they need.
For more information or to start contracting with America's Choice, contact Breeze FMO today.
OR
Network Options:
BCBS Network:
Nationwide Network
Choose between Preferred Provider Organization (PPO) OR Exclusive Provider Organization (EPO)
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BLUE CROSS/BLUE SHIELD, BLUE CROSS/BLUE SHIELD OF NEBRASKA, or ANY BCBS affiliate OR company is NOT the owner/administrator or any other related entity to this plan.
BCBS of NE is SOLELY the NETWORK for Providers/Facilities
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PHCS Network:
Nationwide Coverage
Referenced-Based Pricing (RBP)
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PHCS, ANY PHCS affiliate OR company is NOT the owner/administrator or any other related entity to this plan.
PHCS Practitioner & Ancillary Network is SOLELY the NETWORK for Providers/Facilities
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About America's Choice:
who is americas choice for?
America's Choice health plans are uniquely structured, since they have a self-employment, gig force, independent contractor (1099), etc., requirement, as defined by the Internal Revenue Service (IRS) and because of this unique stipulation, they fall under the jurisdiction of the Department of Labor through ERISA. This distinction ensures that America's Choice adheres to a different set of guidelines and standards, focused on providing comprehensive health coverage tailored for self-employed individuals, gig workers, and 1099 contractors.
How Do Plans like this work?
These plans are approved by the U.S. Department of Labor by the Employee Retirement Income Security Act of 1974 (ERISA), which is a federal law that sets minimum standards for most voluntarily established retirement and health plans in private industry to provide protection for individuals in these plans and these types of plans are becoming more and more common each year due to their tax benefits and structuring.
For self-employed individuals, gig workers, and independent contractors who purchase their insurance independently (e.g., through the Health Insurance Marketplace), they will most likely receive Form 1095-A. If they purchase insurance through an association or another means that falls under ERISA regulation, they will most likely receive Form 1095-B. America's Choice will send IRS Form 1095 each year, to the client, to be retained for tax record purposes.
Are there Appointment fees under america's choice plans:
America's Choice can offer innovative and flexible health insurance solutions that align with the specific needs and requirements of those working outside traditional employment frameworks (self-employment, gig force, independent contractor (1099), etc.) Your contract to write America's Choice serves as and IS your appointment.
We do not charge for any State appointments, and we do not report appointments to ANY State's Department of Insurance, so this appointment will NEVER show on any of your state insurance licenses at all.
If you are licensed and contracted, you are able to legally offer America's Choice health plans to your leads and clients.
General FAQs (Apply to BOTH Network Types)
**For additional, separate FAQ for each specific network type, please see that section's FAQ**
HOW do I get contracted to sell America's Choice?
Click the GET CONTRACTED button above and complete the request.
Once completed, you will receive three emails from Breeze FMO (they will come from: [email protected]) and those requirements must be completed. (PLEASE CHECK YOUR SPAM, PERIODICALLY.)
Once you receive the emails and complete the requirements within, your portal, even though you receive the login information for it, may NOT be active for up to 48 hours.
ADD the above email to your EMAIL CONTACTS / TRUSTED SENDERS inside your email so you can ensure that the emails do not go to SPAM because this email is the email that we coordinate/follow-up with you for any issues with your clients, training, commission issues etc...
Are there any appointment fees to sell America's Choice?
NO, there are NO appointment fees for any State.
Are these Guaranteed Issue plans?
NO, this is a Medically Underwritten Plan. There are 11 "knockout" questions that will disqualify an individual and those questions apply to everyone who will be on the plan.
Dependent child(ren) covered through the end of the month they turn 26. Domestic partners are NOT covered. ONLY legal spouses to be covered. Please answer question for you and all your dependents to be covered.
If they (Anyone that would is applying for coverage, to include family members, answer YES to ANY of the questions below, they will not qualify for this plan.
Those questions are:
1) Have you or any of your dependents applying for coverage, been under the care of a doctor currently, or in the past 5 years for any of the following conditions: cancer, heart disease (including Bypass), Heart Attack, Heart Surgery, or Stroke?
2) Have you or any of your dependents applying for coverage, been home bound, incapacitated, or incapable of self-support due to a medical condition in the past 5 years?
3) Have you or any of your dependents applying for coverage, been under the care of a doctor currently or in the past 5 years for autoimmune or blood disease ( i.e., Lupus, MS, Anemia, AIDS, HIV, Hemophilia, IBS, Crohn's)?
4) Have you or any of your dependents applying for coverage, been under the care of a doctor currently or in the past 5 years for organ failure or organ transplant for kidney, liver, lung, heart and or any form of organ support (i.e., dialysis)?
5) Are you or any of your dependents applying for coverage currently pregnant or expecting?
6) Are you or any of your dependents applying for coverage, currently being treated for condition(s) in which you have been hospitalized for in the past 5 years?
7) Have you or any of your dependents applying for coverage, been under the care of a doctor currently or in the past 5 years for respiratory disorders (i.e, Emphysema, Chronic Bronchitis, COPD or Chronic Pneumonia)?
8) Have you or any of your dependents applying for coverage, been under the care of a doctor currently or in the past 5 years for musculoskeletal disorders (i.e. Back Disorders, Muscular Dystrophy, Cerebral Palsy, Dermatomyositis, Compartment Syndrome, Sciatica, or Osteoporosis?
9) Have you or any of your dependents applying for coverage, been under the care of a doctor currently or in the past 5 years for substance abuse or substance dependency?
10) Have you or any of your dependents applying for coverage, been under the care of a doctor currently or in the past 5 years as a Type 1 Diabetic?
11) In the past 5 years, have you or anyone applying for coverage had a surgery that you are still being treated for? Or have an upcoming planned surgery?
Can I write a "CHILD ONLY" policy with any America's Choice Product?
NO. A child can be listed as a dependent but NEVER as a standalone plan due to the SELF-EMPLOYMENT requirement of the plans.
What ages of people can be to be enrolled in or stay on America's Choice plans?
To be allowed under this plan, all primary applicants and spouses MUST be at least age 18 and up until their 65th birthday. On their 65th birthday, they MUST be removed from these plans for MEDICARE.
Dependents can be any age up to their 26th birthday, at which time, they MUST come off of the plan.
Is self-employment, as defined by the IRS, required to be on every America's Choice plan?
YES.
The requirement exists for ALL of the plans under the America's Choice product offering.
In the event that the PRIMARY applicant is no longer self-employed, as defined by the IRS, they, along with their family, if applicable, MUST be removed from these plans because legally, they MUST be self-employed to be on these plans.
Who should be listed as the PRIMARY APPLICANT on the policy?
The person who is self-employed, as defined by the IRS, MUST be the primary applicant on the policy because it is their qualification that allows them to be on the plan.
If both the primary and spouse are self-employed, as defined by the IRS, then we suggest using the YOUNGER of the two as the primary if it is advantageous to them since the rates are based off of the age of the primary applicant.
When are the monthly premiums deducted/charged from the client's bank account or charged to their credit card?
Even though policies can be written 75 Days in the future, the initial premium will be deducted IMMEDIATELY from the client's bank account or charged to their card, whichever means the client chose. Every following premium will be deducted/charged on the 20th of each month.
If your client is NOT ready to be charged immediately, reach back out ON or PRIOR to the 20th of the PRIOR month so that their coverage may be effective as of the 1st of the coming month. (Which should the month they opted for coverage to start.)
We recommend reaching out a few days before the 20th so as to allow time for any errors, issues with client signatures, etc.
I have a bigger agency OR I have downlines can I get a higher than "street" commission level?
Yes, however, you must book an appointment with us to see exactly what level of commission your agency will qualify for but these spots are limited and are at the SOLE discretion of Breeze FMO.
You can book an appointment with us by clicking HERE.
We look forward to discussing your future with us at Breeze FMO.
How and when would I be paid? As-earned or advanced?
ALL commissions are paid "AS-EARNED" only and we REQUIRE Direct Deposit.
Breeze FMO pays out on ALL Americas Choice products once a month (on the 15th of each month which on your bank statement will show as "WMA") and the policy MUST be active to be paid for that month. We do not allow advances on policies sold so that we can avoid chargebacks for our agents.
I see you have "LEVEL COMMISSIONS." What does that mean, exactly?
Level Commissions means you will receive the same commission amount for the respective policy for the LIFE of that policy so long as that policy is paid up-to-date.
The commissions don't drop to sub-10% levels like other plans. What you receive the FIRST month, you will receive the 100th month, if that plan is still active and paid up.
However, if you are contracted as a Licensed Only Agent (LOA) under some other agency, even if that agency is a downline to Breeze FMO, you must have a Producer Agreement in place with that upline of yours that specifically states your commissions. Breeze FMO is not responsible for any LOA agent commissions because we pay the LOA's upline, who is SOLELY responsible for paying their LOA downlines.
I see these products are for 1099 and Self-Employed Individuals and their families but are they available for 1099 and Self-Employed Groups?
Not at this time.
Do America's Choice plans have Maternity, Mental Health, and Drug and Alcohol Rehabilitation benefits?
YES, each plan covers benefits as stated inside each Plan's respective brochures/summary of benefits, however, plans ONLY cover maternity for the PRIMARY OR SPOUSE and NOT for dependents.
I see America's Choice offers both PHCS and BCBS Network plans that have HSA in the plan name. Does that mean the plan comes with a qualifying HSA?
NO.
This means that the plan is HSA ELIGIBLE. You cannot put an HSA with a health plan that is NOT an HSA-ELIGIBLE plan with ANY carrier. Please follow the laws and regulations for the State that you are writing the plan in AND the IRS so that you don't potentially harm your client. HSA Eligible plans are great BUT there are stricter laws and governance that applies to them. Please ensure that you are following the local, state, and federal laws that apply to HSA Eligible plans and HSAs.
Does the client have to be a Citizen of the United States?
NO, they do NOT have to be a citizen...however, they DO have to have a 9-digit Social Security Number OR Permanent Resident Number issued by the U.S. Government.
Is there an enrollment fee associated with these plans that my client would have to pay?
NO.
Is there a different premium amount that will have to be paid or a credit card fee if my client chooses to pay with a credit card instead of a bank withdrawal?
YES. Using a credit card instead of a bank account will incur a 3 percent, PER MONTH, additional fee for the credit card processing fee.
We recommend, whenever possible, to urge your clients to use their bank account instead of a credit card for this reason.
Will appointments show on my insurance license?
NO. Our contract with you serves as your appointment and we do not believe agents should have to pay a "fee" to an "appointing entity".
Our process is completely within the confines of the law for legality and compliance.
Is Breeze FMO a captive agency?
No way! Not in a million years! We believe in your TRUE INDEPENDENCE. Break the chains! We wouldn't want to be held captive and we respect your autonomy. This is a GREAT product to have in your portfolio and your monthly commissions will grow RAPIDLY!
NETWORK:
**The plan cards below are up-to-date as of 5/27/2024 but to ensure you are getting the most up-to-date information, please click on the PLAN DETAILS button below the respective plan.
$1,500 GigCare PPO 2025
Major Medical Plan
This plan is a GigCare PPO product that utilizes the Blue Cross and Blue Shield of Nebraska Network which includes the below deductibles, and out-of-pocket maximums as well as $0 copay wellness, 24/7 telemedicine, mental health, Wholeistic™ health coaching, identity protection and much more.
Key Plan Details
In Network Deductible – Ind/Fam: $1,500 / $3,000
Out-of-Network Deductible - Ind/Fam: $3,000 / $6,000
In Network Out-of-Pocket Max: $7,350 / $14,700
Out-of-Network Out-of-Pocket Max: $20,000 / $40,000
In Network Primary Office Visit Copay: $20 per visit
In Network Specialty Visit Copay: $40 per Visit
In Network Urgent Care Copay: $60 per Visit
Telemedicine: $0 Copay when using My Live Doc Online Portal
$2,500 GigCare PPO 2025
Major Medical Plan
This plan is a GigCare PPO product that utilizes the Blue Cross Blue Shield of Nebraska Network which includes the below deductibles, and out-of-pocket maximums as well as $0 copay wellness, 24/7 telemedicine, mental health, Wholeistic™ health coaching, identity protection and much more.
Key Plan Details
In Network Deductible – Ind/Fam: $2,500 / $5,000
Out-of-Network Deductible - Ind/Fam: $5,000 / $10,000
In Network Out-of-Pocket Max: $7,350 / $14,700
Out-of-Network Out-of-Pocket Max: $20,000 / $40,000
In Network Primary Office Visit Copay: $25 per visit
In Network Specialty Visit Copay: $40 per Visit
In Network Urgent Care Copay: $60 per Visit
Telemedicine: $0 Copay when using My Live Doc Online Portal
$5,000 GigCare EPO 2025
Major Medical Plan
This plan is a GigCare EPO product that utilizes the Blue Cross and Blue Shield of Nebraska Network which includes the below deductibles, and out-of-pocket maximums as well as $0 copay wellness, 24/7 telemedicine, mental health, Wholeistic™ health coaching, identity protection and much more.
Key Plan Details
In Network Deductible – Ind/Fam: $5,000 / $10,000
Out-of-Network Deductible - NO Out-of-Network Coverage
In Network Out-of-Pocket Max: $7,350 / $14,700
Out-of-Network Out-of-Pocket Max: NO Out-of-Network Coverage
In Network Primary Office Visit Copay: $25 per visit
In Network Specialty Visit Copay: $40 per Visit
In Network Urgent Care Copay: $75 per Visit
Telemedicine: $0 Copay when using My Live Doc Online Portal
$7,350 GigCare EPO 2025
Major Medical Plan
This plan is a GigCare EPO product that utilizes the Blue Cross and Blue Shield of Nebraska Network which includes the below deductibles, and out-of-pocket maximums as well as $0 copay wellness, 24/7 telemedicine, mental health, Wholeistic™ health coaching, identity protection and much more.
Key Plan Details
In Network Deductible – Ind/Fam: $7,350 / $14,700
Out-of-Network Deductible - NO Out-of-Network Coverage
In Network Out-of-Pocket Max: $9,200 / $18,400
Out-of-Network Out-of-Pocket Max: NO Out-of-Network Coverage
In Network Primary Office Visit Copay: $25 Copay
In Network Specialty Visit Copay: $40 Copay
In Network Urgent Care Copay: $100 Copay
Telemedicine: $0 Copay when using My Live Doc Online Portal
HSA Eligible Plan (BCBS PPO Network Only)
$5,000 GigCare PPO HSA 2025
Major Medical Plan (HSA Eligible)
This plan is a GigCare HSA PPO product that utilizes the Blue Cross and Blue Shield of Nebraska Network which includes the below deductibles, and out-of-pocket maximums as well as $0 copay wellness, 24/7 telemedicine, mental health, Wholeistic™ health coaching, identity protection and much more.
Key Plan Details
In Network Deductible – Ind/Fam: $5,000 / $10,000
Out-of-Network Deductible - Ind/Fam: $10,000 / $20,000
In Network Out-of-Pocket Max: $6,550 / $13,100
Out-of-Network Out-of-Pocket Max: $20,000 / $40,000
In Network Primary Off Visit Copay: Deductible & Coinsurance
In Network Specialty Visit Copay: Deductible & Coinsurance
In Network Urgent Care Copay: Deductible & Coinsurance
Telemedicine: $0 Copay when using My Live Doc Online Portal
(** Telemedicine Copay is Subject to change according to the Consolidated Appropriations Act, 2023.)
BCBS PPO Network FAQs (Applies ONLY to BCBS Network Plans)
When are the MONTHLY PREMIUMS deducted/charged from the CLIENT's Bank Account or charged to their card, if applicable?
Even though policies can be written 75 Days in the future, the initial premium will be deducted IMMEDIATELY from the client's bank account or charged to their card, whichever means the client chose. Every following premium will be deducted/charged on the 20th of each month.
If your client is NOT ready to be charged immediately, reach back out ON or PRIOR to the 20th (please allow time for client signatures) of the PRIOR month so that their coverage may be effective as of the 1st of the coming month. (Which should the month they opted for coverage to start.)
Are SPECIALTY MEDICATIONS covered on the BCBS PPO Network Plans?
Most of the specialty medications that an agent will need coverage for by a client have coverage with certain restrictions, but NOT all specialty medications are covered. The ultimate call is that of GigCare.
If the specific specialty medication has coverage, most, if not all, will require medical necessity, pre-authorization, and will be subject to dosage limitations and will be subject to the copay required per the specific plan.
For example, someone who is ONLY taking Ozempic for weight loss, without having a medical need due to Diabetes Type II and who doesn't get it preauthorized will certainly be rejected.
**Note that we, at Breeze FMO, CANNOT speak for GigCare nor the Blue Cross Blue Shield of Nebraska network so for further guidance, please see the Summary of Benefits and refer to the Broad Network C and PDL 40 for Blue Cross Blue Shield of Nebraska PPO Network as stated in the Summary of Benefits.
Is precertification required?
Some services may require Preauthorization. If a service requires precertification, failure to obtain Preauthorization will result in denial of benefits.
Please see the plan documentation for further clarification.
For plans that have a DEDUCTIBLE, when does the DEDUCTIBLE reset?
Deductibles reset every CALENDAR YEAR...NOT POLICY YEAR, regardless of when the plan becomes effective.
Please keep your clients informed with the correct information.
Where can I find the Provider Lookup?
You can find the Provider Lookup for the Blue Cross Blue Shield of Nebraska PPO Network by clicking HERE.
When would the client's "renewal be"?
Their plan would "renew" on their POLICY ANNIVERSARY.
**NOTE: Please remember that deductibles, for plans that have one, reset every CALENDAR YEAR, not POLICY YEAR.
When can plans be started? (On what date?)
If the application is complete and E-signed ON or BEFORE the 18th of the Month, the plan CAN start as early as the 1st of the upcoming month. The reason for the "can start" is because these plans can be written 75 days out. For example, a plan application completed between the 1st and all the way up to the 18th (including the 18th), of June the plan could be set to start on July 1st.
If the plan is complete and e-signed ON of AFTER the 19th of the month, it would not be able to start until the 1st of the NEXT month. For example, a plan application completed on June 19th would not be able to start until August 1st.
IMPORTANT NOTE: A policy is NOT complete for approval until the Client has signed ALL required documents and in each respective space required. This is VERY important!
Does the BCBS HSA plans come with a "built-in" Health Savings Account?
NO.
The HSA plan is to be used in conjunction with an external qualifying HSA but this plan is a "QUALIFYING HEALTH PLAN" and can have an HSA added with it purchased from an outside source of the agent's/client's choosing.
A great resource to check out involving HSAs can be found HERE.
Are the GigCare PPO Blue Cross/Blue Shield Network Plans on a Plan Year Deductible OR a Calendar Year Deductible?
These PPO Network Plans are on a CALENDAR YEAR DEDUCTIBLE; and the deductible resets EVERY January 1, regardless of when the policy starts or becomes effective.
Can a client change their plan at any time?
A client can change their plan from the GigCare (BCBS PPO or EPO Options) to the Detego (PHCS RBP Options) or vice-versa ONLY IN THE FIRST 30 DAYS of the plan being active.
Outside of that, the following rules apply:
For the GigCare (BCBS PPO Network Plans), the Calendar Year will be the beginning of the year for the plan in reference to Open Enrollment so changes to these plans will be allowed during the traditional OE period of November 1 to December 5th of each year prior to the coming 1st day of January.
*Please note that any FEDERAL extensions for OE ONLY apply to plans purchased on the Exchange or Marketplace and any extension of such shall NOT apply to any of these Detego or GigCare plans.
**Please see the official documentation for any changes as these rules could change at any time per the carrier and they are the overall authority for such matters.
NETWORK:
**The plan cards below are up-to-date as of 5/27/2024 but to ensure you are getting the most up-to-date information, please click on the PLAN DETAILS button below the respective plan.
$500 Titanium RBP 2024
Major Medical Plan
The $500 Titanium Plan includes the below copays, deductibles, and out of pocket maximums as well as $0 copay wellness, 24/7 telemedicine, mental health, Wholeistic™ health coaching, identity protection and much more.
Key Plan Details
In Network Deductible – Ind/Fam: $500 / $1,000
In Network Out-of-Pocket Max- $7,350 / $14,700
Out of Network Deductible – Ind/Fam: $1,000 / $2,000
Out of Network Out-of-Pocket Max – Ind/Fam: $20,000 / $40,000
Office Visit Copay - $25 Copay in Network
Spec Visit Copay - $40 Copay in Network
Urgent Care Visit - $60 Copay in Network
ER Visit - Deduct/Co-Ins
Telemedicine Copay - $0 Copay
$1,000 Diamond RBP 2024
Major Medical Plan
The $1000 Diamond Plan includes the below copays, deductibles, and out of pocket maximums as well as $0 copay wellness, 24/7 telemedicine, mental health, Wholeistic™ health coaching, identity protection and much more.
Key Plan Details
In Network Deductible – Ind/Fam: $1,000 / $2,000
In Network Out-of-Pocket Max- $7,350 / $14,700
Out of Network Deductible – Ind/Fam: $2,000 / $4,000
Out of Network Out-of-Pocket Max – Ind/Fam: $20,000 / $40,000
Office Visit Copay - $25 Copay in Network
Spec Visit Copay - $40 Copay in Network
Urgent Care Visit - $60 Copay in Network
ER Visit - Deduct/Co-Ins
Telemedicine Copay - $0 Copay
$1,500 Platinum RBP 2024
Major Medical Plan
The $1500 Platinum Plan includes the below copays, deductibles, and out of pocket maximums as well as $0 copay wellness, 24/7 telemedicine, mental health, Wholeistic™ health coaching, identity protection and much more.
Key Plan Details
In Network Deductible – Ind/Fam: $1,500 / $3,000
In Network Out-of-Pocket Max- $7,350 / $14,700
Out of Network Deductible – Ind/Fam: $3,000 / $6,000
Out of Network Out-of-Pocket Max – Ind/Fam: $20,000 / $40,000
Office Visit Copay - $25 Copay in Network
Spec Visit Copay - $40 Copay in Network
Urgent Care Visit - $60 Copay in Network
ER Visit - Deduct/Co-Ins
Telemedicine Copay - $0 Copay
$2,500 Gold RBP 2024
Major Medical Plan
The $2,500 Gold Plan includes the below copays, deductibles, and out of pocket maximums as well as $0 copay wellness, 24/7 telemedicine, mental health, Wholeistic™ health coaching, identity protection and much more.
Key Plan Details
In Network Deductible – Ind/Fam: $2,500 / $5,000
In Network Out-of-Pocket Max- $7,350 / $14,700
Out of Network Deductible – Ind/Fam: $5,000 / $10,000
Out of Network Out-of-Pocket Max – Ind/Fam: $20,000 / $40,000
Office Visit Copay - $25 Copay in Network
Spec Visit Copay - $40 Copay in Network
Urgent Care Visit - $60 Copay in Network
ER Visit - Deduct/Co-Ins
Telemedicine Copay - $0 Copay
$3,500 Silver RBP 2024
Major Medical Plan
The $3500 Silver Plan includes the below copays, deductibles, and out of pocket maximums as well as $0 copay wellness, 24/7 telemedicine, mental health, Wholeistic™ health coaching, identity protection and much more.
Key Plan Details
In Network Deductible – Ind/Fam: $3,500 / $7,000
In Network Out-of-Pocket Max- $7,350 / $14,700
Out of Network Deductible – Ind/Fam: $7,000 / $14,700
Out of Network Out-of-Pocket Max – Ind/Fam: $20,000 / $40,000
Office Visit Copay - $25 Copay in Network
Spec Visit Copay - $45 Copay in Network
Urgent Care Visit - $60 Copay in Network
ER Visit - Deduct/Co-Ins
Telemedicine Copay - $0 Copay
$5,000 Bronze RBP 2024
Major Medical Plan
The $5,000 Bronze Plan includes the below copays, deductibles, and out-of-pocket maximums as well as $0 copay wellness, 24/7 telemedicine, mental health, Wholeistic™ health coaching, identity protection and much more.
Key Plan Details
In Network Deductible – Ind/Fam: $5,000 / $10,000
In Network Out-of-Pocket Max- $7,350 / $14,700
Out of Network Deductible – Ind/Fam: $10,000 / $20,000
Out of Network Out-of-Pocket Max – Ind/Fam: $20,000 / $40,000
Office Visit Copay - $25 Copay in Network
Spec Visit Copay - $45 Copay in Network
Urgent Care Visit - $60 Copay in Network
ER Visit - Deduct/Co-Ins
Telemedicine Copay - $0 Copay
$7,350 Copper RBP 2024
Major Medical Plan
The $7,350 Copper Plan includes the below copays, deductibles, and out-of-pocket maximums as well as $0 copay wellness, 24/7 telemedicine, mental health, Wholeistic™ health coaching, identity protection and much more.
Key Plan Details
In Network Deductible – Ind/Fam: $7,350 / $14,700
Out of Network Deductible - Ind/Fam: $14,700 / $29,400
In Network Deductible – Ind/Fam: $2,500 / $5,000
Out of Pocket Max: $7,350 / $14,700
Office / Spec Visit Copay: $25 / $40
Urgent Care Copay / ER Visit: $60 / Deduct/Co-Ins
Telemedicine Copay: $0 Copay
HSA Eligible Plans (PHCS Practitioner & Ancillary Network Only)
$2500 HSA RBP
Major Medical Plan (HSA Eligible)
The $2500 HSA Plan includes the below deductibles, and out of pocket maximums as well as telemedicine, mental health, Wholeistic™ health coaching, fitness benefits, identity protection and more.
Key Plan Details
Deductible – Ind/Fam: $2,500 / $5,000
Out of Pocket Max: $6,550 / $13,100
Office / Spec Visit Copay: 20% After Deductible
Urgent Care Copay / ER Visit: 20% After Deductible
Telemedicine: Included
$3500 HSA RBP
Major Medical Plan (HSA Eligible)
The $3500 HSA Plan includes the below deductibles, and out of pocket maximums as well as telemedicine, mental health, Wholeistic™ health coaching, fitness benefits, identity protection and more.
Key Plan Details
Deductible – Ind/Fam: $3,500 / $7,000
Out of Pocket Max: $6,550 / $13,100
Office / Spec Visit Copay: 20% After Deductible
Urgent Care Copay / ER Visit: 20% After Deductible
Telemedicine: Included
$5000 HSA RBP
Major Medical Plan (HSA Eligible)
The $5,000 HSA Plan includes the below deductibles, and out-of-pocket maximums as well as telemedicine, mental health, Wholeistic™ health coaching, identity protection and more.
Key Plan Details
Deductible – Ind/Fam: $5,000 / $10,000
Out of Pocket Max: $6,550 / $13,100
Office / Spec Visit Copay: 20% After Deductible
Urgent Care Copay / ER Visit: 20% After Deductible
Telemedicine: Included
LIMITED BENEFIT PLANS (PHCS PRACTITIONER & ANCILLARY NETWORK)
Americas Choice 250 Deductible
Annual Max Plan
The America's Choice 250 Deductible Million Dollar Plan includes the below copays, $250 deductible, 24/7 telemedicine, mental health, Wholeistic™ health coaching, identity protection and much more.
Key Plan Details
Deductible – Ind/Fam: $250/$500
Maximum Annual Benefit: $1,000,000 Per Person Per Year
Maximum Lifetime Benefit: $5,000,000 Per Person
Office / Spc Visit / Urgent Care Copay: $50/10 Visit per Benefit Period Max
ER Visit Copay: $250 AFTER Deductible
Telemedicine Copay: $0 Copay, $0 Deductible
Americas Choice 500 Deductible
Annual Max Plan
The America's Choice 500 Deductible Plan includes the below copays, $500 deductible, 24/7 telemedicine, mental health, Wholeistic™ health coaching, identity protection and much more.
Key Plan Details
Deductible – Ind/Fam: $500/$1,000
Maximum Annual Benefit: $1,000,000 Per Person Per Year
Maximum Lifetime Benefit: $5,000,000 Per Person
Office / Spec Visit / Urgent Care Copay: $50/10 Visit per Benefit Period Max
ER Visit Copay: $250 AFTER Deductible
Telemedicine Copay: $0 Copay, $0 Deductible
Americas Choice 750 Deductible
Annual Max Plan
The America's Choice 750 Deductible Million Dollar Plan includes the below copays, $0 deductible, 24/7 telemedicine, mental health, Wholeistic™ health coaching, identity protection and much more.
Key Plan Details
Deductible – Ind/Fam: $750/$1,500
Maximum Annual Benefit: $1,000,000 Per Person Per Year
Maximum Lifetime Benefit: $5,000,000 Per Person
Office / Spec Visit / Urgent Care Copay: $50/10 Visit per Benefit Period Max
ER Visit Copay: $250 AFTER Deductible
Telemedicine Copay: $0 Copay, $0 Deductible
PHCS RBP Network FAQs (Applies ONLY to PHCS Practitioner & Ancillary Network Plans)
When are the MONTHLY PREMIUMS deducted/charged from the CLIENT's Bank Account or charged to their card, if applicable?
Even though policies can be written 75 Days in the future, the initial premium will be deducted IMMEDIATELY from the client's bank account or charged to their card, whichever means the client chose. Every following premium will be deducted/charged on the 20th of each month.
If your client is NOT ready to be charged immediately, reach back out ON or PRIOR to the 20th (please allow time for client signatures) of the PRIOR month so that their coverage may be effective as of the 1st of the coming month. (Which should the month they opted for coverage to start.)
Are SPECIALTY MEDICATIONS covered on the PHCS RBP Network Plans?
No. Specialty Medications are NOT covered under any of the PHCS network plans.
Is precertification required on the PHCS Network Plans?
YES. Precertification is required for all in-hospital admissions, imaging (CT/PET/MRI/MRA), home health, skilled nursing, hospice, DME (over $500), chemotherapy/radiation, organ transplants, sleep studies, prosthetics/orthotics, therapies (chiropractic, cardiac, PT/OT/ST), and outpatient surgery.
Please refer to the plan document for a complete list of all services that require precertification under your plan. A 50% (up to $2,500) penalty will apply for not obtaining precertification.
For plans that have a DEDUCTIBLE, when does the DEDUCTIBLE reset?
Deductibles reset every CALENDAR YEAR...NOT POLICY YEAR, regardless of when the plan becomes effective.
Please keep your clients informed with the correct information.
Where can I find the PHCS Network Provider Lookup?
Follow the instructions below:
1.) Click "Find a Provider" in the top right-hand corner
2.) Acknowledge you have read the disclaimer
3.) Click on the green "Select Network" button
4.) Choose "PHCS"
5.) Choose "Practitioner and Ancillary" from the list
6.) Enter search criteria and zip code
When would the client's "renewal be"?
Their plan would "renew" on their POLICY ANNIVERSARY.
**NOTE: Please remember that deductibles, for plans that have one, reset every CALENDAR YEAR, not POLICY YEAR.
When can plans be started? (On what date?)
If the application is complete and e-signed ON or BEFORE the 23rd of the Month, the plan CAN start as early as the 1st of the upcoming month. The reason for the "can start" is because these plans can be written 75 days out. For example, a plan application completed between the 1st and all the way up to the 23rd (including the 23rd), of June the plan could be set to start on July 1st.
If the plan is complete and e-signed ON of AFTER the 24th of the month, it would not be able to start until the 1st of the NEXT month. For example, a plan application completed on June 24th would not be able to start until August 1st.
There are NO exceptions to this rule.
Do the PHCS HSA plans come with a "built-in" Health Savings Account?
NO.
The HSA plan is to be used in conjunction with an external qualifying HSA but this plan is a "QUALIFYING HEALTH PLAN" and can have an HSA added with it purchased from an outside source of the agent's/client's choosing.
A great resource to check out involving HSAs can be found HERE.
Can a client change their plan at any time?
A client can change their plan from the Detego (PHCS RBP Option) to the GigCare (BCBS PPO or EPO Options) or vice-versa ONLY IN THE FIRST 30 DAYS of the plan being active.
Outside of that, the following rules apply:
For the Detego (PHCS RBP Option), the 12-month renewal date will be the beginning of the year for the plan in reference to Open Enrollment so changes to these plans will be allowed during the OE period (defined in the next sentence) PRIOR to their plan anniversary.
For example, a plan that would renew on August 1, the Open Enrollment period for the PHCS Network Plan that they are on would be from June 1st to July 5th PRIOR to the August 1st date.
*Please note that any FEDERAL extensions for OE ONLY apply to plans purchased on the Exchange or Marketplace and any extension of such shall NOT apply to any of these Detego or GigCare plans.
**Please see the official documentation for any changes as these rules could change at any time per the carrier and they are the overall authority for such matters.
You CANNOT cancel a PHCS Network plan for a BCBS Network Plan or vice-versa! They MUST wait until the Open Enrollment period for that particular plan that they are on.
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