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. |
