Association Health Plan

A Forward-Thinking Health Care Strategy

Leverage PECAA’s group buying power to take advantage of a Member-only health care solution at competitive rates through a private, non-profit, level-funded benefits plan.

Introducing PECAA’s Association Health Plan

We are proud to introduce PECAAHP, a Member-exclusive health care solution that provides affordable health care coverage for you and your employees.

With insurance premiums on the rise and no end in sight, PECAAHP was developed to help Member practices gain control of their expenses while providing quality benefits to employees – helping your practice attract and retain a quality team.

Leverage PECAA’s group buying power as part of a larger, combined unit to purchase health care benefits at competitive rates, regardless of your individual practice size. Join your fellow PECAA colleagues by taking advantage of this private, non-profit, level-funded benefits plan (using the Cigna network).

Learn More In Our Overview Video

Watch the video below to learn more about the new level-funded benefits plan offered through the Cigna network and how you go about getting your free no-obligation quote.

Why A Level-Funded Program?

A level funded health plan is a type of health insurance plan that combines the cost savings and customization of self-funding with the financial safety and predictability of traditional, fully-insured plans. Level funding used to be a concept only available to large employers. Not anymore. Experience the advantages of level-funding through PECAAHP without taking on added risk.

  • Various Plan Design Options make it easy for you to find the right fit for your practice
  • An Experienced Team is always ready to provide expertise before, during & after you’ve chosen your plan

Level-Funded Program Key Advantages

  • One Predictable Monthly Payment
    -Your monthly payment is determined upfront and guaranteed not to increase for a full year as long as there are no changes to your group’s benefits or enrollment
  • Plan Administration & Account Management
    -Payments of claims, customer service and reporting is all done for you, leaving you to focus on your business
  • Quality Benefits
    -All employer-established benefit plans are minimum essential coverage
    -Preventative services are paid 100% when received from in-network providers

Choosing Your Plan

PECAAHP offers multiple Medical Plans that include PPO & HSA Options:

1. Cigna National Network
Preferred Provider Organization (PPO) plans give you flexibility. You can go to any health care professional you want without a referral – inside or outside of your network. Staying inside your network means smaller copays and full coverage. If you choose to go outside of your network, you’ll have higher out-of-pocket costs, and not all services may be covered.

2. Reference Based Pricing (RBP)

RBP is an open access strategy that combats the rising cost of hospital-based medical care. Our RBP plans use a PHCS network for doctors, but you can go anywhere you choose for hospital-based services. The plan will pay the hospital a fair and reasonable amount based on local health care market costs and trends, usually between 120 and 300% of the Medicare reimbursement.

Health Benefit Plan Features

We provide flexible plan design options, with deductibles ranging from $1500 to $7350, including an option that is compatible with a Health Savings Account (HSA).

ENROLLING IS SIMPLE!

Here’s What to Expect…

1) Get Your FREE No Obligation Quote

To begin the process of getting a quote for your practice, please complete the interest form below.

You will receive a link for a Personal Health Questionnaire (PHQ) to distribute to each of your employees. Once all employees have completed the PHQ, your quote will be generated within 4 – 7 business days.

GET A QUOTE

2) Select A Plan

Once you are contacted with your underwriting results, you can select the medical plan that meets your needs, and the needs of your employees. Many practices may opt to choose two medical plans to give employees options. You will also have the opportunity to incorporate a dental plan and other supplemental benefits to round out your benefits package. Some coverages will require a contribution from the practice, and some will be fully funded by the employees’ payroll deductions.

3) Complete Your Paperwork

Anderson Thornton Consultants will guide you through all the paperwork that is necessary for you to enroll in PECAAHP.*

*Please note that you must maintain a PECAA Membership and be in good standing to qualify for the PECAAHP plan.

FREQUENTLY ASKED QUESTIONS

Employer FAQ’s

What Size Employer Can Join PECAAHP?
The plan requires that two employees enroll in coverage. This can be a doctor and spouse as long as the spouse is on the practice's payroll as an employee, AND the practice has at least one other employee on payroll, even if that other employee waives coverage or is ineligible for benefits. This requirement is what differentiates group coverage from a standard individual or family health plan. Group benefit plans must be offered to all active employees meeting eligibility criteria to remain compliant and non-discriminatory in accordance with regulations from the IRS and the Department of Labor.
What Network of Providers Do You Use?
PECAAHP uses the Cigna PPO Network. This is a nationwide network, contracting with hospitals and other providers.

View the Provider Network List here.

You also have the option of using a Reference Based Pricing Plan, which uses the PHCS network for doctors, but is open access for hospitals.

View the Provider List On PHCS here.
How Does the Billing Work?
Each practice receives a bill from the plan administrator.
What Does the Employer Need to Provide to Obtain a Quote?
The practice will complete an interest form, providing information about your practice, your employees, and your current health plan. After submitting the form, you'll receive a secure link to share with employees so they can complete a Personal Health Questionnaire (PHQ). Once all employees on the census have completed and submitted the PHQ, underwriting will review and generate a quote. Upon review of the quote via web-conference with Anderson Thornton Consultants, the practice can either accept or reject the quote. If accepted, there will be additional paperwork for the practice to submit get started.
How Many People Does the Employer Have to Offer This To?
To stay compliant with labor laws, you need to offer this plan to each employee working more than 30 hours per week. A minimum of two employees must enroll.
Does Everyone In the Office Need to Sign Up for the Same Plan?
No, the practice can offer two or, sometimes, three plans for their employees. When more than one plan is offered, employees can select the plan that best fits their needs.
How Much Does the Practice Have to Pay for the Employee's Coverage in PECAAHP?
The practice must contribute 50% of the employee only cost. If more than one plan is offered, the practice may opt to pay 50% of the lowest cost plan. The practice may choose to contribute more than 50% as part of the hiring and employee retention plan, but 50% is the mandated contribution.
Can the Employer and Employee Pretax These Benefits?
Yes, the cost of these benefits can be taken on a pretax basis, as long as the correct compliance documents are on file. Anderson Thornton Consultants can assist you in setting up a Section 125 plan that will allow you to pretax your benefits.
Who Handles COBRA and Other Compliance Concerns for this Plan?
The administrator handles COBRA and other compliance requirements.
How Will Enrollments Be Done?
Once all employees have completed their applications and the quoted rates have been issued, the employer will either accept or reject the offer. If the offer is accepted, employees will be given the option to sign up or waive.
Will This Interface With My Payroll System?
There are certain payroll systems that accept electronic data feeds. You will also receive access to a benefits administration portal that will help you in managing payroll deductions, new hires, terminations and more.
What Is An Association Health Plan?
Our association health plan allows for active PECAA Members to save money on health insurance premiums. We have been able to leverage the buying power of PECAA to decrease costs for our Members. Since we are able to spread risk across all participating practices, we’re able to keep costs in check and insulate Members from the rising premiums that other insurance carriers have from year to year.
Why Do We Have to Get a Quote, Aren't the Prices Set Up Through PECAA?
The PECAA Health Plan requires underwriting in order to obtain rates. While this is an association health plan, rates vary based on the health of your practice, along with regional factors. The only way to calculate that portion of the premium is to gather information from the Personal Health Questionnaires (PHQ) completed by the employees. This is done in a HIPAA compliant secure portal. The practice administrator will not be able to see the employees’ answers to the health questions, but he/she will be able to see if the PHQ has been completed or not.
What Other Benefits Are Available Through PECAAHP?
To round out your benefits packages for your employees, and to support your recruiting and retention goals, PECAAHP also includes dental and supplemental benefits. The supplemental benefits include an Accident plan, a Critical Illness plan, and voluntary life insurance coverages. Other coverages may be available depending on your practice needs.

Employee FAQ’s

Is My Doctor In the Network?
PECAAHP features the Cigna PPO Network. To see if your doctor is in the Cigna network, View the Provider Network List Here.

If you opt for a reference-based pricing plan option, the PHCS Practitioner network is used. View the Provider Network List Here.
What If I Have an Emergency or Need to Have Surgery?
In cases of emergency, call 911 or go to the emergency room. Emergency care is always treated as In-Network.

If you have to have surgery, your plan will require that your doctor receive authorization for the procedure prior to your admission to the hospital. If you have the reference-based pricing (RBP) plan option, the cost of your hospitalization will be negotiated between the plan administrator and the hospital at the time of authorization. You’ll be responsible for your deductible, plus up to 20% of the charges, up to the plan’s out-of-pocket maximum.

If you have the Cigna PPO option, the plan will pay 80% to 100% of the PPO discounted price, once your deductible has been satisfied.

In either case, it would be best to contact the Advocacy team (call the number on the ID card), since they can help you navigate these processes.
How Much Will This Plan Cost Me?
The rates are based on the health of your practice and regional factors. The actual cost to the employee will be based on the underwritten rates and the employer’s contribution. The practice is required to contribute a minimum of 50% of the base employee only cost. Employees pay for their portion of the premiums with pretax payroll deductions.
When Can I Enroll?
Benefit eligible employees will be able to enroll once the employer has accepted the PECAAHP. Employees working a minimum of 30 hours per week on a regular basis will be considered eligible. New hires will be required to meet the waiting period set by the employer prior to joining the plan. In most cases, employee coverage begins on the first of the month following a 60-day waiting period.
How Do I Enroll?
Eligible employees will use the secure benefits portal to complete underwriting and enrollment.
How Do I Add My Spouse Or Child to the Plan?
Employees who want to add coverage for dependents should include their dependents on their Personal Health Questionnaire. Dependents not enrolled at the initial enrollment can be added at the next open enrollment or when a qualifying event occurs. Qualifying events include, but are not limited to marriage, divorce, birth of a child and loss of other coverage. Employees have 30 days to notify the administrator when a qualifying event happens and changes need to be made.
What Happens If I Leave My Employer?
Employees will be eligible for COBRA continuation coverage when they separate from the practice, or when they transition from full to part time. Employees have 60 days after termination or reduction of hours to elect COBRA with the plan administrator.

Questions?

Don’t see your question on the list? You may e-mail pecaa@andersonthornton.com or call 813-979-1588.

Download Our Ultimate Checklist for Running a Successful Optometry Practice

This checklist will help audit key areas of your practice and guide you toward sustainable, long-term success and growth.

Download Checklist
Join
Contact Us

Please complete the following form to download the ultimate checklist for running a successful optometry practice. 

CooperVision

CooperVision is one of the world’s leading manufacturers of soft contact lenses and related products and services. Their products are sold in over 100 countries around the world.

Carl Zeiss Vision is an industry leader in lenses and coatings, delivered through a nationwide network of Rx Laboratories.

HOYA Vision Care of the Americas makes and supplies ophthalmic lenses to Eye Care Professionals located within the United States, Canada, and South American countries. HOYA supplies a complete range of high-quality lens designs, coatings, and materials.

Johnson & Johnson Vision

Johnson and Johnson Vision is an industry leader in soft contact lenses, including their globally recognized brand ACUVUE®.

Luxottica is an industry leader in the supply of frames & accessories, offering a robust portfolio of over 20 internationally recognized brands.

Safilo Group is the fully integrated Italian eyewear creator and worldwide distributor of quality and trust, a leader in the premium sector for sunglasses, optical frames, and sports eyewear.

VSP is a global leader in optical, offering the following lines of business: VSP® Vision Care (vision benefits and services), Marchon®and Altair® (sunwear and eyewear), Eye Designs (interiors and merchandising systems), and VSP Optics Group (ophthalmic products and lab services).