Preview
SB/A Freedom Protect Plans
The Freedom Protect Plans marketed by DAC are not your typical health coverages. The Freedom Protect Plan is a partially self-funded health care coverage program regulated by ERISA. ERISA is the Federal Law that sets the standards for over 60% of employer established health care plans in private and public sector industry. The Freedom Protect Plans is not Health Insurance. It is an ERISA medical health benefit plan.
Freedom Plans are NOT health insurance.
Imagine zero deductible, first dollar coverage, no medical underwriting, no pre-existing condition exclusions, Affordable Care Act (ACA) mandated coverages, and more – plus nationwide preferred provider networks that includes over 4000 primary hospitals and most licensed board-certified physicians. The Freedom Protect Plans offer “no deductible” coverage with the flexibility, affordability, and usability so you can now effectively manage your health care. You purchase the amount of coverage that you believe best fits your needs and life- style. The Freedom Protect Plan is not for everyone – if your annual coverage needs are expected to exceed The Freedom Plans annual limitations, you should consider additional industry available options.
The Sponsor or the Employer
must be a member of the SB/A CoOp
to take advantage of the Freedom Plans.
Freedom Protect Plans Benefits Example
| The SBA Freedom Protect Plans | PLAN B Individual $365 Family $580 Base Plan Annual Benefit Limit Individual $20,000 Family $40,000 In-Network Provider (PPO) only |
| Annual Deductible | None |
| Co-Insurance Percentage Covered (Plan Pays based on Contracted Amounts) | 50% Co-Insurance on first $10,000 plus 80% of next $10,000 |
| Member Annual Out-of-Pocket Maximum | Individual $7,000 Family $14,000 |
| Primary Care Office Visits Providers limited to Internal Medicine, Family Practice, Pediatrician, and OB/GYN – Office and Other Outpatient Services (CPT-4 99201-99215) | $20 copay per visit 5 (Limited to 3 visits – excluded from Out-of-Pocket Maximum of $7,000) Additional visits at Co-Insurance to $20,000 |
| Inpatient/Outpatient Hospitalization and Professional Services, Medical and Surgical Professional Services, ER/Urgent Care, Lab, X-ray and Imaging, Ambulance Service, Chiropractic Care, Inpatient/Outpatient Psych and Substance Abuse | 50% Co-Insurance 6 on first $10,000 plus 80% of next $10,000 |
| Inpatient (Medical and Surgical) and Outpatient (Surgical only) Hospitalization and Professional Services. Excludes Outpatient Drugs, Kidney Dialysis, Chemo Therapy, and All Other Infusion Drugs | Not applicable |
| Preventative Care | Covered by PCB |
| Prescription Pharmacy Benefit | 50% Co-Insurance on first $10,000 plus 80% of next $10,000 |
| 24 Hour Virtual Clinic – Online and Telephonic Doctor Calls | 100% No co-payment required |
| Carreington Dental Discounted Benefits | Fee Schedule |
| Annual Maximum of Covered Services | Individual $20,000 Family $40,000 |
| Preventive Care Benefits – Routine Well Care – As provided under the Affordable Care Act (ACA) | |
| Adult, Women, Child Preventative Services Screening and Services | Covered by Preventive Care Benefits |
Some benefits do have exclusions. Plan Provisions are the rules or conditions regarding what can be done in a plan. Every plan is different so make sure you read the details.
