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| Q: | What do I need to do to switch over from my current coverage to the new Builders Benefits, Inc. coverage?
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| A: | Complete the Employer Enrollment form that was included in the mailing you received and first fax it to the fax number referenced on the form, then return the form directly to the PBA Benefits Trust in the envelope provided. It is important to include Employee Enrollment/Change Forms for each of your currently enrolled employees, and your premium for the new plans, as outlined on the new Builders Benefits statement included with this mailing.
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| Q: | Am I still permitted to offer dual medical plan options to my employees and their dependents? If so, are there any restrictions?
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| A: | Builders Benefits will allow you to continue to offer the same number of options as you have today with the exception of the Traditional and Traditional Plus plans.
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| Q: | Am I required to select the exact same medical and Rx plan design or can I change benefits?
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| A: | For ease of transition, we have mapped your current benefits to comparable Builders Benefits plans on the enclosed statement. You may continue with the comparable plan or elect to change your medical and/or Rx plan at this time. If you want to change benefit plans, please note your selection of medical and Rx plans on the Employer Enrollment Form and return it to the PBA Benefits Trust, along with the appropriate premium.
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| Q: | Why should I switch over to Builders Benefits plans now?
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| A: | By transitioning to Builders Benefits now, you will enjoy the following advantages:
- Reduced Premiums.
- No medical underwriting for current member groups that convert by the January 20th for a February 1 effective date.
- All deductibles will be satisfied for the remainder of 2006 if you enroll with an effective date of December 1st 2006. Deductibles will reset to the appropriate level January 1, 2007. This applies to both in network and out of network deductibles.
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| Q: | My company includes employees who live outside of Pennsylvania. How will their coverage be impacted if we switch to Builders Benefits?
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| A: | Employees residing outside of Pennsylvania will be enrolled in a Builders Benefits Out-of-Area (OOA) plan that is similar to the in-area plan. The OOA plan will utilize the First Health national provider network. Rates for OOA plans are the same as the in-area plans if you switch before February 2007.
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| Q: | If we switch effective December 1st or January 1st to Builders Benefits plans, when will our next renewal occur?
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| A: | Your next renewal with Builders Benefits will be effective January 1, 2008. That means you can lock in a reduced rate and save for 12 or 13 months depending on when you switch to Builders Benefits. February 1st enrollment will have a renewal date of February 1, 2008.
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| Q: | What if I wait until February 1st or after to switch?
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| A: | You will be required to enroll and provide tax documentation and medical information.
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| Q: | Will we continue to be billed the same way if we switch to Builders Benefits?
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| A: | You will receive a new, easy to read invoice from Builders Benefits for your medical coverage. Your dental, vision, life and disability products will continue to be billed as they are today.
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| Q: | Are the doctors and hospitals that my employees and their dependents use in the new network?
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| A: | Builders Benefits will be offering a quality, state-wide network in Pennsylvania — the Health Assurance network. You can search for your provider in the enclosed Provider Directory or online at www.buildersbenefits.com. If you have questions or need assistance, please call 1-888-221-2550.
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| Q: | What are the differences in the coverage between our current benefits and those with Builders Benefits?
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| A: | The PBA Benefits Trust has developed plans comparable to your current plans. Additional plan options are also available. We recommend that you review the Builders Benefits Medical and Rx Group Plan Comparison Sheets for detailed benefits information. Because indemnity plans, typically referred to as traditional plans, do not contribute to the management of health care costs, the Traditional and Traditional Plus plans have not been duplicated, but the materials include a suggested plan for your group's transition.
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| Q: | Does this change in medical and Rx impact my group's dental or vision coverage rates and/or their renewal dates?
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| A: | No, your dental and vision coverage, along with any life or disability plans, are unaffected by this transition. The dental and vision plan will still renew on April 1, 2007.
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| Q: | We currently offer a QHDHP with a Health Savings Account (HSA). Are we permitted to switch prior to January 1st? Who provides the Health Savings Account (HSA) administration for the new Builders Benefits program?
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| A: | You are permitted to change plans prior to January 1st. Please call for details. CBSA — Corporate Benefits Services of America provides the administration of the Health Savings Account for Builders Benefits.
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| Q: | What do my employees and their dependents do if they need medical care while traveling outside our service area?
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| A: | Emergency Care — In the event of a life threatening medical situation, members should seek care immediately from the nearest hospital. The applicable Emergency Room copayment will apply to these services; however copayments are waived if admitted. Urgent Care — For urgent care outside of the service area call 1-866-676-7424 to locate a First Health provider. Urgent care services that are deemed medically necessary services will be covered at the participating levels outlined on the schedule of benefits. All other services will be covered at the non-participating level.
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| Q: | Why did the PBA Benefits Trust decide to switch to self-insured instead of staying fully-insured?
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| A: | First, to take full advantage of our member's good claims experience; second, to save on administrative costs; and third, to turn carrier profits into savings for our members.
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| Q: | We currently offer Senior 65 through the PBA Benefits Trust. How do we transition these employees over to the Builders Benefits Medicare program?
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| A: | Your active senior employees will be enrolled in the same plan as the rest of your employees. The plan will coordinate benefits with Medicare. For your retired senior employees, we are offering Seniors Choice Retiree Medical Insurance Plan, underwritten by PacifiCare Life and Health Insurance Company.
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| Q: | We have an employee who is actively working. Is he/she required to enroll in Seniors Choice or is he/she permitted to enroll in the Builders Benefits medical plans.
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| A: | If your employee is actively working, he/she is not eligible for Seniors Choice. This employee will be enrolled in the same plan as the rest of your active employees. |
