General Plan Overview

EBT is a benefit plan established and controlled by the trustees of the Evangelical Society of Churches, Inc. (ESOC) a 501(c)(3) evangelical church association with “common bonds and religious convictions”. Participation in EBT is contingent upon maintaining an annual membership in ESOC. EBT is a single employer “church plan” as defined under section 33(A) of the Employee Retirement Income Security Act (ERISA) of 1974 as amended.

Each employer may select and provide the benefit plan that fits their pocketbook and the needs of their employees and dependents. The plan can include medical, prescription drugs, dental, vision or short term disability coverage. Each participating minister or employee receives a Summary Plan Description (rather than an insurance policy) describing all the benefits provided. Each employee receives an identification card showing the selected preferred provider.

The Plan purchases insurance direct from the world insurance market under one policy. Under this insurance arrangement all eligible medical benefits are re-insured by certain qualified “A” rated (or better) Underwriters at Lloyd’s, London. There is no need for a primary domestic insurer, a major savings in itself. While the Plan is not covered by any state GUARANTY association, the insurers are required to guarantee the full amount of all outstanding U.S. claims with security held in a trust in the United States.

The healthcare rates for each participating employer group are based on the discounted cost of benefits in the geographic area where the employees and dependents reside, their actual age, sex, family status and the general medical condition of the employer group.

The insurance for the healthcare Plan is provided through R. J. Wilson & Associates Ltd., a reinsurance brokerage house and direct correspondent with Underwriters at Lloyd’s, London. The plan administration, payment and processing of claims is provided by Medical Benefits Administrators of MD, Inc., a well known third party administrator domiciled in Maryland using all the latest state of the art information and benefit processing systems.

Group life and AD&D coverage is also available through an “A” rated national group life insurance company.

Major Plan Features

Major Medical

Comprehensive Major Medical Benefits are provided up to $1,000,000 per employee and their dependents per person per year and a lifetime maximum of $2,000,000 per person. Without general claims experience, medical information may be required at inception but such information is used for group rating purposes only. Additional new employees will be added subject to the rules of HIPAA.

Re-Insured

Under the insurance arrangement large claims of eligible employees or dependents incurred during the Period of Insurance are re-insured by qualified “A” (or better) rated Certain Underwriters at Lloyd’s, London.

Contributions

Rates are calculated using the specific medical costs for your plan and the specific zip code of your employees. Overall rates may be adjusted up or down each six months, allowing for more accurate rate trending calculations. We make an effort not to assume overly conservative long term trend factors, trying to avoid surprise double digit rate increases.

Preferred Providers

Before you change doctors, we´ll change networks. EBT has several National & Regional PPO networks available. To see a complete list go to our PPO map and/or PPO list.

Utilization

Each employee has access to a toll free line that they may call 24 hours per day, 7 days per week for pre-certification of inpatient, outpatient, and elective procedures, diagnostics, therapies, network guidance, and other needs. The utilization program includes concurrent, and retrospective review, as well as a second opinion program. Participation in EBT will allow for an appeals process as well as access to additional national and international networks. EBT also provides specific large claim management services with a focus to facilitate more individualized and coordinated care.

Administrators

EBT is administered exclusively by Medical Benefits Administrators of MD, Inc. [MBA], an R. J. Wilson & Associates Ltd. affiliate. MBA processes all claims, provides day to day management, as well as assumes the fiduciary duties of "plan administrator." All tax and other required filings are made by MBA.

MBA is a full service benefit administration firm affiliated with R. J. Wilson & Associates Ltd. the reinsurance intermediary providing the insurance for EBT. MBA provides the claims administration for EBT. 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.

R. J. Wilson & Associates Ltd. provides all underwriting services. All administration services are provided by or through MBA for one level management fee to reduce cost.

Other Benefits

Of course, EBT provides a selection of group life, accidental death and dismemberment coverage written on a true group basis for groups of ten or more. Optional dental and vision coverage is also available.