Company News :::

Oct. 1
PPHP of the Northshore Launches Physicians Search Portal To Better Serve Needs of Clients

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Sept 1
Are You HIPAA Compliant?
Review complete online overview of HIPAA and the new regulations.

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July 1
PPHP of the Northshore Launches New Web Site To Better Serve Needs of Clients

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


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

• 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.


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