Frequently Asked Questions | To walk
you through the process, we have answered some of the most frequently asked questions regarding the AdvantageCare program. |
| About AdvantageCare: | Q: What is AdvantageCare?
A: AdvantageCare is a new , non-profit employee healthcare program designed exclusively for
Brunswick gold and platinum dealers and their employees. Benefits are provided through the Independent Retailers Benefit
Trust, a fully insured employee benefit plan that meets all federal standards including ERISA and HIPAA. Some of the
major plan features include:
• Comprehensive medical and prescription drug coverage
• Benefits are
fully guaranteed by qualified “A” rated insurers
• Easy access to local, regional and national PPO networks
like PHCS (www.phcs.com) and First Health (www.firsthealth.com)
• Additional coverage is available for vision, dental, group
life, and short-term disability
• Up to $1 million per covered person per year
• All benefits are fully
guaranteed to the 1st eligible dollar
• Plan deductibles starting at $250
Q: What is the minimum
number of employees required to participate in the program?
A: To qualify for the program, a Brunswick Dealer firm
must have at least 2 full-time eligible employees. Firms with four or less full-time employees must have 100%
of eligible employees participate in the program, those with five or more must have at least 75% of eligible employees
participating in the program.
If you do not have enough participating employees to qualify for the Brunswick Group
Plan, we also offer Individual/Family health insurance coverage in most states. For more information about this coverage, please refer to the Individual Health section of the website.
| Q:
In what states is the AdvantageCare program available?
A: The program is currently available
in all states and the District of Columbia with the exception of Hawaii, Nevada, Texas, and Washington state. Brunswick
is working with state regulators to gain program acceptance in Nevada, Texas, and Washington in the near future. The
program will never be available to dealers in Hawaii due to federal ERISA regulations.
Q: How do
I sign up for the program?
A: First, you must contact an AdvantageCare representative directly
at (866) 641-8836, or via you local AXA Advisor representative. After verifying that you are a Gold or Platinum level
dealer, you will be asked to complete a Proposal Request Form and fax it back to the number indicated. This is the
first step of the process.
Q: As a Silver level dealer, can I still get a quote for healthcare coverage? A: Yes, a Silver level dealership
can secure a quote for healthcare coverage; however, the dealership will not be eligible to participate until it achieves
Gold or Platinum status.
Q:
Is healthcare available to part-time or seasonal workers?
A:
Healthcare is available only to full-time employees. Full-time employees are defined as employees who average 30 or more hours
per week and are included on the dealership’s tax and wage statement.
Q: What is my exposure as part of the trust?
A: There is no fee to join the Independent Retailers Benefit Trust
(“Trust”). The only requirement of payment of the dealer is to remit the respective contribution
amounts applicable to the benefit plan selected.
Q: What happens if the company decides to cancel this program?
A: You will have at least 60 days to secure a new healthcare provider
during which time you will continue to enjoy coverage - all claims due for the period of coverage under the trust will be
paid appropriately, under an arrangement between the Trust and certain Underwriters at Lloyds, London.
Q: How many employees have to agree to coverage?
A: Dealerships with 2-4 full-time employees must have 100% participation
by those employees who do not have other sources of healthcare coverage. Dealerships with 5 or more employees must have
75% participation by employees without alternative healthcare coverage.
Q: How is the total number of employees counted with respect to the minimum participation
requirement?
A: Only those
employees who have no other access to health insurance are included in the coverage. Employees who have
access either through personal insurance or coverage through a spouse’s employer are excluded from the calculation.
For example, if your dealership has 10 employees and two of those are covered by spousal insurance, then the dealership
needs 75% of the remaining 8 employees to elect coverage -- 6 employees.
Q: How much does it cost?
A: The plan costs vary by co-pays, deductibles, coinsurance levels, geographic location, age of
employees, and other factors. Your best bet is to obtain a free, no-obligation quote to review your options.
| Q:
Will the AdvantageCare Program save my company money?
A: Each employer may select
and provide the benefit plan that fits their pocketbook and all other things being equal, the cost of providing benefits under
the new Plan has been reduced by 10% to 15% and in some cases as much as 20% or more when compared with other available commercially
insured group benefit plans.
| Q:
How can you save our dealership 10%-15% on an “apples-to-apples” program when our current provider is actually
RAISING our premiums?
A: The Brunswick AdvantageCare Plan is subject to the standards
of the Employee Retirement Income Security Act of 1974 as amended (ERISA). The program is funded through a non-profit trust
governed by firms that serve as Trustees. the Trustees receive a certified annual report from an Independent Auditor.
All participants receive a Summary Annual Report. Therefore, all charges and expenses are clearly visible and there can be
no mystery about where the money goes. Benefit overhead and claim charges are broken out and can be examined and compared
with that of commercial insurers.
The inflationary trend of medical services will no doubt continue but simply
put, the AdvantageCare delivery system is less expensive. All other things being equal the corridor of savings should
continue year after year. Under AdvantageCare each cost component is unbundled, analyzed and either reduced or eliminated.
With this program the participating Brunswick dealer has the flexibility to purchase an employee benefit plan tailored to
fit their pocketbook.
For instance, standard commercial insurers do not take the entire financial risk but cede
a large part of the risk to the world reinsurance market place and for that portion of the risk they are in reality retailers.
For practical purposes, a primary insurer is normally a retailer of a large part of the insurance coverage. The net cost to
the primary insurer is marked up significantly as ceding commission and passed on to the employer in addition to the primary
insurers own cost of administration and overhead required margin for the portion of the risk they retain. By purchasing in
volume, the Trustees of the program purchase the required insurance wholesale direct net of the normal brokerage
and as a not for profit entity have lower administrative and other overhead charges. Yet the benefit claims are subject to
the same preferred provider discounts as commercial insurers.
Further, in addition to the above reduction in the
cost of insurance the Independent Retailers Benefit Trust is a non-profit fund that has no stockholders to pay and any underwriting
and investment gain or unnecessary margin that would have gone to the primary insurer is retained within the trust to reduce
the cost of future benefits.
The Trustees contract with its own Plan Administrator, actuary, claims adjudicator
and claims processing firm. Pre-certification, U/R fees, large case management fees, and preferred provider access fees are
charged direct to the benefit trust at actual cost. Preferred provider discounts are passed on to the Trust in total and the
claims administrator does not receive a percentage of the discount. The Plan Administrator solely represents the plan and
is not compensated by the insurers.
Since the benefit plan itself is not deemed to be insurance and most of the
contributions are paid out directly from the benefit trust what is deemed premium is much less and thus the state premium
taxes are less. For the same reason, while AdvantageCare is subject to all federal mandates, the plan is not subject to state
mandates, state community rating rules, or state small group rules. As a practical matter however, the plan tracks with most
state mandates. In addition, the employer can request an amendment for any benefit provision that may be of concern.
In addition, since the program is made available as an added service to the employer members of the Brunwsick Dealers as
a group, there is no need to establish a complex marketing platform to offer the plan through general agents and various regional
insurance brokers and agents. The member may employ the service of a broker or consultant and compensate them as they wish.
| Q:
Do I need to be a Brunswick Gold or Platinum Dealer in order to sign my company up for this program?
A:
Yes. In order to participate in the AdvantageCare program, a dealer must maintain their gold or platinum dealer
status with Brunswick.
| Q:
Is life insurance available under the plan?
A: Yes. $20,000 employee life insurance is available,
as well as 1 times annual employee salary.
| Q: Can the AdvantageCare Group Benefit Program provide
international coverage?
A: Yes. The plan provides seamless coverage for domestic and international
employees. While abroad, the provider services are tailored to international employees needs.
| Q: What are the maximum limits of
the Plan?
A: $1,000,000 per covered person annually and $2,000,000 per covered person
lifetime, with the option to purchase up to $5,000,000 of lifetime coverage per person.
| Q: What PPO´s are available?
A: National PPO networks: Private Healthcare Systems (www.phcs.com). and First Health (www.firsthealth.com) are the primary national networks. Many other PPO networks are available to
supplement national network coverage. For a full list of PPO networks, including doctors and hospitals participating
in the networks, please go to our PPO Networks page.
| Q: I am currently a subscriber to an HMO. Is this a better or worse
option for me?
A: The AdvantageCare Program can provide benefits not available to
subscribers of many HMO plans. In some circumstances, HMO’s do not have the facilities to provide specialized services
such as transplants. Both an HMO and the AdvantageCare Program have preferred medical providers. With the AdvantageCare
Program, however, your employees can use non network providers if they are willing to pay the differential in coinsurance
and deductible. Individuals that travel may find themselves in an area where they have no HMO coverage. This will not be the
case with the AdvantageCare Program because there is a National PPO. When plan participants are out of their own local
PPO area, they will have access to a PPO. This provides the participants with maximum PPO access.
| Q: If my doctor is not a part of
the PPO, will I need to change doctors?
A: No benefit program or insurer has preferred access
to all medical providers. Most insurers have a PPO network that they own (or partially own) and insist on that network. The
AdvantageCare Plan has access to most PPO providers and the administrator will work with the individual employer in the
selection of their local PPO. Therefore, the chances are good that your doctor will be a part of the selected PPO. If not,
the plan still pays the out of network fees. This would, in most cases, relate only to the doctor and not to a hospital.
| Q:
Can the AdvantageCare Program be tailored to the needs of my specific dealership?
A: Yes.
The summary plan description can be amended to include or exclude certain coverage, limits, varying co-payments, co-insurance
and out-of-pocket maximums. Additional coverage is also available for vision, dental, and group life coverage.
Q:
Is the AdvantageCare Plan categorized as insurance?
A: The AdvantageCare Plan
is not in and of itself insurance. The plan however, purchases insurance direct from the world insurance market under one
policy guaranteeing all of the eligible medical benefits from the first eligible dollar to the limits set forth in the Summary
Plan Description. The benefits under the Independent Retailers Benefit Trust are guaranteed in full from the first eligible
dollar to the limits of the plan by qualified “A” rated underwriters at Lloyd’s London. | |
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Q: Who is Medical Benefits Administrators
of MD (MBA)?
A: MBA is a benefit administration firm affiliated with R. J. Wilson & Associates
Ltd. the reinsurance intermediary providing the insurance for the Independent Retailers Benefit Trust. MBA provides
the underwriting, billing, and claims administration for AdvantageCare. MBA utilizes the state of the art Trizetto Quiclink
System (formerly known as Resource Information Management or “RIMS”) in the management of benefit claims. MBA
also employs Solucient Auto Audit and other similar systems as well as INGENIX (formerly Medicode) in the administration of
claims. MBA and affiliated companies combined provide similar administrative services for fifteen national employer
associations and growing. | | Q:
How are employee and dependent benefit rates established?
A: The Administrator employs the
Tillinghast HealthMaps System with specific assumptions reviewed by actuaries to establish contribution rates. The employee
and dependent group rates are established based on fixed overhead cost; the cost of medical services in the specific geographic
area; the age, sex, family status, and general medical condition of the specific employer group.
| Q: Who is Affintiy Benefit Services LLC
(ABS)?
A: Affinity Benefit Services has been retained by Brunswick and the Plan
Administrator to assist in management of the plan, and to work with the eligible Brunswick dealers in the implementation,
design, presentation, and enrollment of employees and dependents with the program, as well as answering customer service
questions for plan participants. ABS will be working with benefit advisors from AXA to enroll eligible Brunswick dealers
and their employees in the Independent Retailers Benefit Trust program. |
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