What is the monthly cost of the program?
Single - $76.00
Employee + Spouse - $180.94
Employee + Children - $108.56
Family - $186.97
Can I be turned down for coverage?
No, there is no medical underwriting. You will not be turned down for coverage or have to answer health related questions.
What if I have a pre-existing condition?
Pre-existing conditions are covered immediately. They will be covered like any other illness under the terms of the program.
What is the coverage for preventive care?
Coverage for routine exams, and well childcare immunizations is provided and benefit is paid at a preselected fixed dollar.
• $75 per visit/$150 per person, per calendar year maximum
Do I have a prescription drug co-pay?
Prescriptions are discounted at specific pharmacies.
Is maternity covered?
Yes, maternity is covered up to the calendar year maximum as listed in the summary of benefits.
What is SBAA?
Select Benefit Administrators of America (SBAA) is a division of Symetra Insurance Company that offers limited benefit medical insurance. HealthShare program offers benefits through SBAA.
How do I submit a claim?
At the time of a visit or covered event, present your Select Benefits ID card and ask the provider to file the claim directly with SBAA. SBAA will process the claim and send payment directly to the provider. A few weeks after submission, you will be mailed an Explanation of Benefits showing what was paid.
What if my provider won’t submit insurance information?
You may file the claim directly with SBAA, and they will pay benefits based upon the amount covered by your Select Benefits plan. For faster response, please request a copy of the itemized bill from the provider, listing dates of service, and procedure and diagnosis codes. Ask for Health Care Financing Administration (HCFA) forms for doctor’s office visits and Universal Billing (UB92) forms for hospital care.
How can I request a new Select Benefits ID card?
Contact SBAA at 1-800-497-3699 or firstname.lastname@example.org. They will send you a new card.
Where do I get information on continuing my medical benefits if I leave the company?
Contact SBAA. They handle all extension of benefits administration.
How do I add dependents to my plan?
Fill out a new enrollment form within 31 days of the eligibility date and give it to your company.
If I want to use my coverage and have not yet received my insurance card, what information do I need to give my provider?
Ask your company for the Select Benefits case number before your visit. At the office, give your provider this number along with the SBAA customer service phone number, 1-800-497-3699.
Can I use this plan if I already have a major medical plan?
Your plan pays regardless of any other coverage you or your spouse may have.
Whom do I contact if I have a change in my name or address or if there is an error on my ID card?
Contact SBAA at 1-800-497-3699 or email@example.com.
Whom can I contact if I have questions about my benefits?
Please contact SBAA at 1-800-497-3699 or firstname.lastname@example.org. Customer service representatives are available Monday through Friday, 6:30 a.m. to 5:00 p.m., Central Time.
* If you have any questions regarding your medical plan, please refer to plan details.