APMA Health-Care Solutions | Membership | APMA
Health-Care Solution
APMA Health-Care Solutions

APMA is pleased to announce an exclusive new member benefit: APMA Health-Care Solutions. If you’ve struggled to find affordable health coverage for yourself, your family, and your office staff, this new benefit is for you.

Our large- and small-group health plan solutions can save you 15–30 percent on the cost of health insurance coverage.

APMA Health-Care Solutions:

Large-Group (15+ participants)

  • Self-insured program through a medical captive and customized plans with robust coverage using major carrier provider networks
  • Outstanding customer support

Small-Group (2+ participants/minimums may vary by state) - excluding NY participants

  • Level funded insurance program
  • Three robust plan options utilizing major carrier provider networks
  • Medicare solutions
  • Outstanding customer support

Small-Group (2+ participants) – NY participants

  • Fully insured plans
  • Utilization of a Health Reimbursement Arrangement (HRA) to reduce the net deductible
  • Medicare solutions
  • Outstanding customer support

Check out each tab to learn more, then get a quote to see how much you could save.

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Large Group

These solutions are designed for large groups of 15 or more enrollees. They offer:

  • Flexible plan development to help you meet your practice’s needs
  • Pay for what you use
  • Clearly identified costs
  • Lower back-end administrative costs such as third-party administrators, advisors, and pharmacy

Learn More and Request a Quote

Have a question we haven’t answered below? Email support@novetahealth.com for a consultation with Noveta Health.

  1. How did APMA decide on this solution for members?
  2. What is a medical captive?
  3. Is this solution a health plan sponsored by APMA?
  4. Why did APMA partner with Noveta Health?
  5. How does Noveta Health lower costs while delivering excellent benefits?
  6. Which major carrier provider networks does Noveta Health use?
  7. Who is eligible for the insurance coverage?
  8. Will family coverage be offered? What about dental and vision insurance?
  9. Can a practice get coverage if it has locations in more than one state?
  10. Will the insurance be a “skinny plan?”
  11. Are wellness programs and materials available?
  12. Will my employees experience any difficulty switching to Noveta Health?
  13. National averages say employers switch their health plans every two years because of rising premiums. What is Noveta Health’s retention ratio?
  14. Do Noveta Health’s plans create additional work for my staff?
  15. Can I switch to Noveta Health’s plan any time of the year?
  16. Will participants have access to an online portal to monitor claims?
  17. Does Noveta Health carry supplemental and additional insurance?
  18. If my large group develops a high-deductible plan, will a Health Savings Account (HSA) be available?

How did APMA decide on this solution for members?

Health insurance through the current major carrier system is unsustainable for most practices, which have to adjust benefits almost annually in order to keep premium increases as low as possible. APMA researched several solutions for members, including traditional options such as Association Health Plans (AHPs) and various affinity programs. Finding the right solution was a challenge. APMA is a national membership organization whose members practice in a variety of settings, creating a diverse set of insurance needs. These factors, combined with ensuring regulatory compliance, drove APMA to investigate non-traditional solutions that would reduce costs while providing great coverage. We determined that the best answer for our members in large groups is a medical captive. Noveta Health is the medical captive APMA has selected as its health insurance partner. Noveta Health has also developed groundbreaking, fully-insured plan options for small groups.

What is a medical captive?

A medical captive is a health insurance pool formed by companies joining together to reduce the cost of their medical benefits. Successful member companies maintain good loss histories and effective cost containment strategies. A captive is a form of self-insurance that is considered low risk.

Here are a few quick facts about self-funded insurance plans:

  • 9 out of 10 organizations with more than 1,000 employees have chosen employer self-funded health insurance plans. The plans are more cost-effective, more efficient, and provide greater control and insight into cost-drivers compared to traditional insurance.
  • For small to mid-size companies, self-funded insurance has not always been practical. The pooling of many employers creates the efficiency of a larger organization and helps to achieve reduced costs.
  • APMA changed its staff plan to the medical captive solution in August 2018. As a result, your association achieved a 30-percent reduction in medical spending, while our benefits remained unchanged.

Is this solution a health plan sponsored by APMA?

No. The insurance solutions are separate policies directly between you or your practice and Noveta Health.

Why did APMA partner with Noveta Health?

Noveta Health is a full-service benefit consultant with proven solutions that can significantly lower your health-care and pharmacy costs.

How does Noveta Health lower costs while delivering excellent benefits?

Noveta eliminates excess administrative costs and prescription claims by pursuing all available rebates. You only pay for services you use and don’t pay mark-ups that line the pockets of major carrier CEOs.

Which major carrier provider networks does Noveta Health use?

Aetna, BCBS, Cigna, United Healthcare, and others.

Who is eligible for the insurance coverage?

All employees of a practice not covered by Medicare are eligible—physicians and other staff. Groups can be podiatry-only or multispecialty. Beginning in year two of the plan, all DPMs must be current members of APMA in order to participate.

Will family coverage be offered? What about dental and vision insurance?

Yes. Yes. All standard classes will be offered—Employee Only, Employee + Spouse, Employee + Child(ren), and Family. Additionally, dental and vision insurance can be added to your plan.

Can a practice get coverage if it has locations in more than one state?

Yes. Multi-state plans are available. Noveta Health is registered in all 50 states, Puerto Rico, and the District of Columbia.

Will the insurance be a “skinny plan?”

No. Only full-coverage plans will be offered.

Are wellness programs and materials available?

Absolutely! Wellness programs and materials are integral to the health plans. Wellness is the best way to contain costs.

Will my employees experience any difficulty switching to Noveta Health?

There will be minimal disruption. Like any change from one carrier to another, there are instances in which an employee’s provider does not participate in the new provider network, but it is rare.

National averages say employers switch their health plans every two years because of rising premiums. What is Noveta Health’s retention ratio?

Noveta’s retention ratio is 95 percent. The other 5 percent leave mainly due to company acquisitions.

Do Noveta Health’s plans create additional work for my staff?

None!

Can I switch to Noveta Health’s plan any time of the year?

Yes, if you are currently fully insured. If you are self-funded, you can switch on your plan’s renewal date.

Will participants have access to an online portal to monitor claims?

Yes, participants will have an online account.

Does Noveta Health carry supplemental and additional insurance?

Yes, Noveta can handle all of your insurance needs.

If my large group develops a high-deductible plan, will a Health Savings Account (HSA) be available?

Yes, you can either continue using your current vendor or Noveta Health can provide a resource.

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Small Group

Note: New York members - please see separate New York Solution tab.

These solutions are designed for groups of two or more* enrollees. They provide:

  • Plan designs are level funded
  • Our plan design is a unique and innovative approach to taking back control of your health insurance
  • Three plan options
  • Plans are designed to have little to nothing out of pocket for our members
  • About 60 percent of employers receive money back at the end of the plan year
  • Our program brings Large-group benefits and rates for your Small Group
  • Lower back-end administrative costs such as third-party administrators, advisors, and pharmacy

Watch this presentation to find out how much you can save today!

*Minimum number of employees depends on state.

Get Started Now!

Plan FAQs

  1. How did APMA decide on this solution for members?
  2. Is this health plan solution sponsored by APMA?
  3. Why did APMA partner with The Ark Group?
  4. Who is eligible for the APMA benefit solutions?
  5. Will family coverage be offered?
  6. Can a practice get coverage if it has multiple locations and/or is in more than one state?
  7. What is the minimum number of employee lives to be eligible? (Note: in some states, dependents are included in the number of participants)
  8. Will the group medical insurance be a “skinny plan?”
  9. Which major carrier provider networks does The Ark Group use?
  10. Are the insurance carriers financially sound?
  11. How does The Ark Group lower costs while delivering excellent benefits?
  12. Can I switch to The Ark Group plans any time of the year?
  13. Will my employees experience any difficulty switching to a plan through The Ark Group?
  14. National averages say employers switch their health plans every two years because of rising premiums. What is The Ark Group’s retention ratio?
  15. Can my company be declined coverage?
  16. Can any one of my employees be declined coverage?
  17. Are pre-existing conditions covered?
  18. Is this plan ACA-Compliant?
  19. Do plans through The Ark Group create additional work for my staff?
  20. Will employers and employees have access to an online portal?
  21. What is a level funded plan?
  22. Does my plan document run on a Calendar year or Plan year basis?
  23. Are wellness programs and materials available?
  24. Does the APMA benefit offering include dental and vision insurance?
  25. Does the APMA benefit offering include supplemental, ancillary, or additional insurance?

Employee FAQs

  1. How do deductibles, copays, coinsurance and out-of-pocket maximums work?
  2. What is a HDHP (High Deductible Health Plan)?
  3. How are prescriptions covered?
  4. Is preventive care covered?
  5. Will a member pay less if you use a network provider?
  6. How do members find a provider?
  7. Will a member need a referral to see a specialist?
  8. How do members estimate the cost of a procedure?
  9. How do members use Telemedicine and Telecounseling?
  10. What is GAP Insurance?
  11. What is Accident Insurance?
  12. What is Critical Illness Insurance?
  13. What if I have a claim?
  14. When will members receive ID cards?
  15. When can members make changes to coverage?
  16. Can members use coverage while out of state or the country?

How did APMA decide on this solution for members?

APMA researched several solutions for members, including traditional options such as Association Health Plans (AHPs) and various affinity programs. Finding the right solution was a challenge. Health insurance through the current system is unsustainable. Most practices are forced to adjust benefits annually to keep premium increases as low as possible. We determined that the best answer for our members in small groups is a level-funded solution provided by The Ark Group. The Ark Group is the organization APMA has selected as its small group health insurance partner.

Is this health plan solution sponsored by APMA?

This solution is not sponsored by APMA, but it is endorsed by APMA. The insurance solutions are set up directly between your company and the insurance carriers provided by The Ark Group.

Why did APMA partner with The Ark Group?

The Ark Group is a full-service, national benefits consulting firm with proven solutions that can significantly lower your health-care costs, while increasing the value of your benefits.

Who is eligible for the APMA benefit solutions?

All employees of a practice not covered by Medicare are eligible, including physicians and other staff. Groups can be podiatry-only or multispecialty. Beginning in year two of the plan, all DPMs in a practice must be current members of APMA in order for the practice to participate.

Will family coverage be offered?

Yes. All standard classes will be offered: Employee Only, Employee + Spouse, Employee + Child(ren) and Family.

Can a practice get coverage if it has multiple locations and/or is in more than one state?

Yes. Multi-location and multi-state plans are available. The Ark Group solutions are available in all 50 states, Puerto Rico, and the District of Columbia. Not all product solutions are available in all states.

What is the minimum number of employee lives to be eligible? (Note: in some states, dependents are included in the number of participants)

The answer depends on the state.

  • Minimum of 2: AL,AZ,GA,IA,ID,IL,IN,KY,MA,MI,MS,NE,NM,OH,PA,SD,SC,TX,VA,WA,WI,WY
  • Minimum of 5: AK,KS,LA,MO,NC*,NV,OK,OR,TN,UT
    *Coverage offered through Trustmark
  • Minimum of 10: AR,CT,CO,DE,FL,MD,ME,MN,NJ,WV
  • Minimum of 15: CA,RI,VT
  • Other: DC,HI,MT,ND,NY,PR (The level funded product solution is not available in these states, fully insured product solutions are available).

The Ark Group may be able to assist groups with coverage that do not meet the minimum number of employee lives

Will the group medical insurance be a “skinny plan?”

No. Only ACA-compliant, full-coverage plans will be offered

Which major carrier provider networks does The Ark Group use?

Our network solutions are national. We use Aetna, Cigna, and PHCS as our primary networks. The network we use for your plan will be the most robust option in your geographical location.

Are the insurance carriers financially sound?

Yes. The Ark Group will only work with Carriers who are “A” rated with AM Best.

How does The Ark Group lower costs while delivering excellent benefits?

The Ark Group has designed a more effective and efficient approach to health insurance. Our proprietary plan design drives claim utilization away from the base medical plan and strategically implements other supplemental insurance and non-insurance products to lower or eliminate your out-of-pocket medical expenses.

Can I switch to The Ark Group plans any time of the year?

Yes. If your employer is currently fully insured, your employer can choose to move plans at any time. Additionally, the new plan would provide deductible credit to make the transition more seamless. If you are self-funded, you can switch on your plan’s renewal date.

Will my employees experience any difficulty switching to a plan through The Ark Group?

There will be minimal disruption. Like any change from one carrier to another, there are instances in which an employee’s provider does not participate in the new provider network.

National averages say employers switch their health plans every two years because of rising premiums. What is The Ark Group’s retention ratio?

The Ark Group is focused on our current clients and providing concierge level service. We believe the best business strategy for growth is taking care of current customers. Our persistency is more than 90 percent. Because we represent multiple insurance carriers, we can bring any carrier solution to the table.

Can my company be declined coverage?

The Ark Group proprietary health plans are ACA-compliant. There are no pre-existing conditions clauses and individual employees cannot be declined coverage. However, underwriting acceptance is based on the risk of each individual group. That said, insurance carriers may decline to insure a group that has substantial claims.

Can any one of my employees be declined coverage?

No. An employee cannot be declined for coverage.

Are pre-existing conditions covered?

Yes.

Is this plan ACA-Compliant?

Yes.

Do plans through The Ark Group create additional work for my staff?

No. In Fact, it is entirely likely that The Ark Group will lessen your current workload.

Will employers and employees have access to an online portal?

Yes.  Employers can access relevant information, such as: invoices, adds/terms, and enrollment data, to name a few. Employees can access relevant information, such as: summary of benefits, educational videos, and certificates of coverage, to name a few.

What is a level funded plan?

Level Funding is a variation of Self-Funded. It is a newer and more innovative option for employers of a certain size trying to find solutions to the rising cost of group health insurance. A Level-Funded plan has the look of a Fully Insured plan but allows an employer complete transparency, which positions everyone to become better, more informed health-care consumers and positions employees to save money by paying for the cost of small claims while managing a portion of their own risk.

Does my plan document run on a Calendar year or Plan year basis?

This answer depends on the plan document that you currently have in force.

Are wellness programs and materials available?

Absolutely! Wellness programs and materials are integral to our health plan solutions. Wellness can be an effective way to contain claim costs.

Does the APMA benefit offering include dental and vision insurance?

Yes. The APMA member benefit offering includes both dental and vision insurance. 

Does the APMA benefit offering include supplemental, ancillary, or additional insurance?

Yes. The exclusive benefits offering for APMA members is robust and includes access to group life, short term disability, long term disability, voluntary benefits, and a full suite of individual insurance products as well. The Ark Group can service all your insurance needs.

How do deductibles, copays, coinsurance and out-of-pocket maximums work?

  • Deductible: This is the dollar amount of medical expenses that needs to be met prior to your co-insurance being available.
  • Co-Insurance: This is the percentage of medical expenses that is shared between you and the insurance carrier after the deductible has been met.
  • Copays: This is a set dollar amount paid at time of service for doctor’s office visits, emergency room visits, urgent care, and prescriptions. Copays do not apply towards your deductible or out-of-pocket maximum.
  • Out-of-Pocket Maximums: This the total amount of medical expense risk you are responsible for per plan year. Once you have met this maximum, the primary insurance carrier covers all remaining medical expense for the remainder of the plan year.

Please see your plan document or summary of coverage for your specific benefit details.

What is a HDHP (High Deductible Health Plan)?

high-deductible health plan (HDHP) is a health insurance plan with lower premiums and higher deductibles than a traditional health plan. It is intended to incentivize consumer-driven health care. Being covered by an HDHP is also a requirement for having a Health Savings Account. These plans do not offer first dollar benefit and the deductible must be met prior to coinsurance beginning.

How are prescriptions covered?

Prescription coverage varies based on the plan option your employer is offering. Please refer to your summary plan description for specific prescription details.

Is preventive care covered?

Yes, preventive care is covered at 100 percent when services are provided in network. As required under the ACA, cost sharing does not apply to identified clinical preventive services. Any other preventive medical services covered under your plan are subject to deductible and coinsurance. You may have to pay for services that are not preventive.  Ask your provider if the services needed are preventive. We encourage the member to use the transparency tool prior to receiving care. We also encourage the member to contact the insurance carrier for verification of benefits.

Will a member pay less if you use a network provider?

This plan uses a provider network.  You will pay less if you use a provider in the plan’s network. You will pay the most if you use an out-of-network provider, and you might receive a bill from the provider for the difference between the provider’s charge and what your plan pays (balance billing). Be aware, your network provider might use an out-of-network provider for some services such as lab work. Always check with your provider before you receive services.

How do members find a provider?

Please refer to your medical ID card, which will show you your network. You may go to your portal or The Ark Group website to conveniently search for providers in your network and area.

Will a member need a referral to see a specialist?

No. You can see the specialist you choose without a referral.

How do members estimate the cost of a procedure?

Our health-care transparency tool allows you to estimate how much you will spend for medical procedures and services. It helps you determine the best value for your money. To get started, go to the Healthcare Bluebook app or website healthcarebluebook.com/cc/myVIPbenefits. Once you have logged in, search for your procedure, review the price range shown on the color bar, then scroll down the page and review the list of facility options by quality and cost.

How do members use Telemedicine and Telecounseling?

Simply call the APMA toll free number 833-694-2103 and listen to the prompts to be connected to your MyTelemedicine representative who will gather some information and connect you with the next available physician or counselor.

What is GAP Insurance?

GAP coverage effectively bridges the out-of-pocket medical expenses on your primary health plan. Because there are still gaps in coverage that fall outside accident and critical illness coverage, GAP plans are used as a personal stop loss coverage so that your actual out-of-pocket expenses for your health care are lower than they ever have been. You might have a high deductible health plan but that does NOT mean you should be completely responsible for paying the deductible and out-of-pocket maximums.

What is Accident Insurance?

Group Accident Insurance complements your medical coverage by helping to ease the financial impact of an accident. It provides you with a payment to use as you see fit and can help with out-of-pocket expenses because of an accident, such as your deductible and maximum out-of-pocket costs left over from your Group Medical plan. You cannot plan for accidents, but you can be better prepared financially to handle them when they do occur. The Ark Group offers Accident Insurance so you can focus more on your recovery and less on your finances. Coverage is for both In-patient and Out-patient actual expenses incurred by you from an accident.

What is Critical Illness Insurance?

Critical Insurance was designed to pay a tax free, lump sum living benefit upon diagnosis of a covered condition but will also pay the benefit to a beneficiary if the insured does not survive the diagnosis. The benefit is paid directly to you and may help cover your deductible and maximum out- of-pocket costs left over from your Group Medical plan.

What if I have a claim?

  • GAP Claim: Simply present your primary and secondary insurance cards every time you see your provider. The provider will file the claim directly with the insurance carrier.
  • Accident Claim: Contact The Ark Group for assistance in completing your claim form.
  • Critical Illness Claim: Contact The Ark Group for assistance in completing your claim form.

When will members receive ID cards?

Once your enrollment is complete, ID cards will be mailed directly from the carrier, and you will receive them in approximately 10–14 days.  If you require treatment prior to receiving your ID cards, we can provide you with a temporary and/or electronic ID card to use.

When can members make changes to coverage?

Changes can be made once a year during your company’s open enrollment or if you have a qualifying life event such as marriage, divorce, birth, adoption, loss or gain of other coverage.

Can members use coverage while out of state or the country?

Your coverage may reimburse for emergency services. However, The Ark Group does provide access to international health insurance. If you are planning a trip outside of the US, please contact us at 833-694-2103.

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New York Solution

These solutions, designed for groups of two or more enrollees, are specific for New York state members. They provide:

  • Fully insured plans
  • Flexible plan options
  • Large-group rates
  • Utilization of a Health Reimbursement Arrangement (HRA) to reduce the net deductible

Find out how much you can save today!

Get Started Now!

Plan FAQs

  1. How did APMA decide on this solution for members?
  2. Is this health plan solution sponsored by APMA?
  3. Why did APMA partner with The Ark Group?
  4. Who is eligible for the APMA benefit solutions?
  5. Will family coverage be offered?
  6. Can a practice get coverage if it has multiple locations and/or is in more than one state?
  7. What is the minimum number of employee lives to be eligible? (This answer is specific to New York only and may be different based on each insurance carrier’s requirement.)
  8. Will the group medical insurance be a “skinny plan?”
  9. Which major carrier provider networks does The Ark Group use?
  10. Are the insurance carriers financially sound?
  11. How does The Ark Group lower costs while delivering excellent benefits?
  12. What is The Difference Card?
  13. Can I switch to The Ark Group plans any time of the year?
  14. Will my employees experience any difficulty switching to a plan through The Ark Group?
  15. National averages say employers switch their health plans every two years because of rising premiums. What is The Ark Group’s retention ratio?
  16. Can my company be declined coverage?
  17. Can any one of my employees be declined coverage?
  18. Are pre-existing conditions covered?
  19. Is this plan ACA-Compliant?
  20. Do plans through The Ark Group create additional work for my staff?
  21. Will employers and employees have access to an online portal?
  22. Does my plan document run on a Calendar year or Plan year basis?
  23. Are wellness programs and materials available?
  24. Does the APMA benefit offering include dental and vision insurance?
  25. Does the APMA benefit offering include supplemental, ancillary, or additional insurance?

Employee FAQs

  1. How do deductibles, copays, coinsurance and out-of-pocket maximums work?
  2. What is a HDHP (High Deductible Health Plan)?
  3. How are prescriptions covered?
  4. Is preventive care covered?
  5. Will a member pay less if you use a network provider?
  6. How do members find a provider?
  7. How do members estimate the cost of a procedure?
  8. How do members use Telemedicine and Telecounseling?
  9. What is The Difference Card?
  10. When will members receive ID cards?
  11. When can members make changes to coverage?
  12. Can members use coverage while out of state or the country?

How did APMA decide on this solution for members?

APMA researched several solutions for members, including traditional options such as Association Health Plans (AHPs) and various affinity programs. Finding the right solution was a challenge. Health insurance through the current system is unsustainable. Most practices are forced to adjust benefits annually to keep premium increases as low as possible. We determined that the best answer for our members in small groups is a level-funded solution provided by The Ark Group. The Ark Group is the organization APMA has selected as its small group health insurance partner.

Is this health plan solution sponsored by APMA?

This solution is not sponsored by APMA, but it is endorsed by APMA. The insurance solutions are set up directly between your company and the insurance carriers provided by The Ark Group.

Why did APMA partner with The Ark Group?

The Ark Group is a full-service, national benefits consulting firm with proven solutions that can significantly lower your health-care costs, while increasing the value of your benefits.

Who is eligible for the APMA benefit solutions?

All employees of a practice not covered by Medicare are eligible, including physicians and other staff. Groups can be podiatry-only or multispecialty. Beginning in year two of the plan, all DPMs in a practice must be current members of APMA in order for the practice to participate.

Will family coverage be offered?

Yes. All standard classes will be offered: Employee Only, Employee + Spouse, Employee + Child(ren) and Family.

Can a practice get coverage if it has multiple locations and/or is in more than one state?

Yes. Multi-location and multi-state plans are available. The Ark Group solutions are available in all 50 states, Puerto Rico, and the District of Columbia. Not all product solutions are available in all states.

What is the minimum number of employee lives to be eligible? (Note: in some states, dependents are included in the number of participants)

The minimum number of employee lives that is required to be eligible, can be as low as 2. Each carrier has different eligibility requirements.

Will the group medical insurance be a “skinny plan?”

No. Only ACA-compliant, full-coverage plans will be offered

Which major carrier provider networks does The Ark Group use?

Our carrier solutions are Aetna NY, Emblem, Empire BCBS, HealthFirst, Health Pass, Oscar, and Oxford. The carrier we use for your plan will be the best option in your geographical location and your unique needs.

Are the insurance carriers financially sound?

Yes. The Ark Group will only work with Carriers who are financially sound.

How does The Ark Group lower costs while delivering excellent benefits?

The Ark Group has designed a more effective and efficient approach to health insurance. Our proprietary plan design drives claim utilization away from the base medical plan and strategically implements other supplemental insurance and non-insurance products to lower or eliminate your out-of-pocket medical expenses.

What is The Difference Card?

The Difference Card disrupts the health-care status quo by helping employers create unique benefit plan designs for their employees. The Difference Card is a medical expense reimbursement plan that allows you to lower your health insurance costs while maintaining a level of benefits that exceeds your company’s expectations. This IRS Section 105 Plan allows employers to establish a tax-free account which members can access to help pay for qualified expenses associated with the underlying carrier medical plan. The Difference Card MERP takes the Health Reimbursement Arrangement (HRA) concept to the next level by providing more flexibility, security, and customization.

Can I switch to The Ark Group plans any time of the year?

Yes. If your employer is currently fully insured, your employer can choose to move plans at any time. Additionally, the new plan would provide deductible credit to make the transition more seamless. If you are self-funded, you can switch on your plan’s renewal date.

Will my employees experience any difficulty switching to a plan through The Ark Group?

There will be minimal disruption. Like any change from one carrier to another, there are instances in which an employee’s provider does not participate in the new provider network.

National averages say employers switch their health plans every two years because of rising premiums. What is The Ark Group’s retention ratio?

The Ark Group is focused on our current clients and providing concierge level service. We believe the best business strategy for growth is taking care of current customers. Our persistency is more than 90 percent. Because we represent multiple insurance carriers, we can bring any carrier solution to the table.

Can my company be declined coverage?

The Ark Group proprietary health plans are ACA-compliant. There are no pre-existing conditions clauses and individual employees cannot be declined coverage. However, underwriting acceptance is based on the risk of each individual group. That said, insurance carriers may decline to insure a group that has substantial claims.

Can any one of my employees be declined coverage?

No. An employee cannot be declined for coverage.

Are pre-existing conditions covered?

Yes.

Is this plan ACA-Compliant?

Yes.

Do plans through The Ark Group create additional work for my staff?

No. In Fact, it is entirely likely that The Ark Group will lessen your current workload.

Will employers and employees have access to an online portal?

Yes.  Employers can access relevant information, such as: invoices, adds/terms, and enrollment data, to name a few. Employees can access relevant information, such as: summary of benefits, educational videos, and certificates of coverage, to name a few.

Does my plan document run on a Calendar year or Plan year basis?

This answer depends on the plan document that you currently have in force.

Are wellness programs and materials available?

Absolutely! Wellness programs and materials are integral to our health plan solutions. Wellness can be an effective way to contain claim costs.

Does the APMA benefit offering include dental and vision insurance?

Yes. The APMA member benefit offering includes both dental and vision insurance. 

Does the APMA benefit offering include supplemental, ancillary, or additional insurance?

Yes. The exclusive benefits offering for APMA members is robust and includes access to group life, short term disability, long term disability, voluntary benefits, and a full suite of individual insurance products as well. The Ark Group can service all your insurance needs.

How do deductibles, copays, coinsurance and out-of-pocket maximums work?

  • Deductible: This is the dollar amount of medical expenses that needs to be met prior to your co-insurance being available.
  • Co-Insurance: This is the percentage of medical expenses that is shared between you and the insurance carrier after the deductible has been met.
  • Copays: This is a set dollar amount paid at time of service for doctor’s office visits, emergency room visits, urgent care, and prescriptions. Copays do not apply towards your deductible or out-of-pocket maximum.
  • Out-of-Pocket Maximums: This the total amount of medical expense risk you are responsible for per plan year. Once you have met this maximum, the primary insurance carrier covers all remaining medical expense for the remainder of the plan year.

Please see your plan document or summary of coverage for your specific benefit details.

What is a HDHP (High Deductible Health Plan)?

high-deductible health plan (HDHP) is a health insurance plan with lower premiums and higher deductibles than a traditional health plan. It is intended to incentivize consumer-driven health care. Being covered by an HDHP is also a requirement for having a Health Savings Account. These plans do not offer first dollar benefit and the deductible must be met prior to coinsurance beginning.

How are prescriptions covered?

Prescription coverage varies based on the plan option your employer is offering. Please refer to your summary plan description for specific prescription details.

Is preventive care covered?

Yes, preventive care is covered at 100 percent when services are provided in network. As required under the ACA, cost sharing does not apply to identified clinical preventive services. Any other preventive medical services covered under your plan are subject to deductible and coinsurance. You may have to pay for services that are not preventive.  Ask your provider if the services needed are preventive. We encourage the member to use the transparency tool prior to receiving care. We also encourage the member to contact the insurance carrier for verification of benefits.

Will a member pay less if you use a network provider?

This plan uses a provider network.  You will pay less if you use a provider in the plan’s network. You will pay the most if you use an out-of-network provider, and you might receive a bill from the provider for the difference between the provider’s charge and what your plan pays (balance billing). Be aware, your network provider might use an out-of-network provider for some services such as lab work. Always check with your provider before you receive services.

How do members find a provider?

Please refer to your medical ID card, which will show you your network. You may go to your portal or The Ark Group website to conveniently search for providers in your network and area.

How do members estimate the cost of a procedure?

Our health-care transparency tool allows you to estimate how much you will spend for medical procedures and services. It helps you determine the best value for your money. To get started, go to the Healthcare Bluebook app or website healthcarebluebook.com/cc/myVIPbenefits. Once you have logged in, search for your procedure, review the price range shown on the color bar, then scroll down the page and review the list of facility options by quality and cost.

How do members use Telemedicine and Telecounseling?

Simply call the APMA toll free number 833-694-2103 and listen to the prompts to be connected to your MyTelemedicine representative who will gather some information and connect you with the next available physician or counselor.

What is The Difference Card?

The Difference Card disrupts the health-care status quo by helping employers create unique benefit plan designs for their employees. The Difference Card is a medical expense reimbursement plan that allows you to lower your health insurance costs while maintaining a level of benefits that exceeds your company’s expectations. This IRS Section 105 Plan allows employers to establish a tax-free account which members can access to help pay for qualified expenses associated with the underlying carrier medical plan. The Difference Card MERP takes the Health Reimbursement Arrangement (HRA) concept to the next level by providing more flexibility, security, and customization.

When will members receive ID cards?

Once your enrollment is complete, ID cards will be mailed directly from the carrier, and you will receive them in approximately 10–14 days.  If you require treatment prior to receiving your ID cards, we can provide you with a temporary and/or electronic ID card to use.

When can members make changes to coverage?

Changes can be made once a year during your company’s open enrollment or if you have a qualifying life event such as marriage, divorce, birth, adoption, loss or gain of other coverage.

Can members use coverage while out of state or the country?

Your coverage may reimburse for emergency services. However, The Ark Group does provide access to international health insurance. If you are planning a trip outside of the US, please contact us at 833-694-2103.

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