Physician Partners Health Plan of the Northshore is considered Single Employer Trusts (SET).

WHAT IS A SET?

SET programs provide health coverage to small employer groups including nationally recognized franchise and association groups.

A SET PROGRAM…
• uses nationally recognized and A-rated carriers for stop loss coverage.
• uses nationally recognized actuaries.
• uses nationally recognized TPAs.
• each employer group is individually underwritten.

Why would a SET Health Plan Be Right for Your Company?
• Lower cost than prevailing community PPO plans.
• All financial and insurance risk shifted to other entities.
• Individually underwritten for unique consideration.

A SET Plan…

• acts as a fully-funded health plan in the eyes of the federal government as it establishes a self-funded medical benefit plan for each member employer and as a result, is not subject to MEWA regulations.
• is a self-funded health plan in terms of group benefit administration in accordance with ERISA and as such is not subject to state mandates.
• is a self-funded health plan in which the first 90% of the contribution is used to pay claims directly and the remaining 10% of the contribution is used to purchase stop loss coverage and to pay all other costs of the plan.
• as a result of the stop loss coverage the employer is not at risk beyond contributions paid and in the event that medical utilization did not use all of the first 90% of contribution, it would be applied to the following year's contributions.
• insures small employer groups of 5 or more employees, treating each employer group individually, underwritten separately and with separate trust accounts for each employer.
• follows and complies with ERISA regulations.
• is a self-funded plan, eliminating the cost of state premium tax.
• has multiple benefit plans including Gold Plan (80/60) and Platinum Plan (90/70); each with a series of deductible and pharmacy benefit options to choose from; and a wellness benefit.
• provides “takeover benefits” with prior group coverage, meaning that if the member/condition was covered under a prior group health plan, it will be covered by the SET Program.
• protects the financial integrity of the individual employer health plans by underwriting each member company on its own risk factors.