FAQ’s

Find answers fast to our Frequently Asked Questions

Q:  I heard there is an injunction in 9 states that currently prohibits any health care plans being offered in the state except for the ACA/Obamacare plans.  What states are currently under the injunction?

A:   Currently, the 8 states that allow NO PLANS except for ACA/Obamacare plans are Connecticut, New York, New Jersey, Massachusetts, Vermont, Rhode Island, Kansas, New Hampshire and Idaho.

Q:  I love the plan and the benefits.  How do I sign up?

A:  The Health Plan for Jewelers insurance benefits were created for members of the Jewelers Suite.   All of the Jewelers Suite benefits are available to every segment of the jewelry and pawn industries, including retail, wholesale, sales representatives and service support vendors, watchmakers, bench jewelers, consultants, pawnshop owners, jewelry designers and specialty shops.  Individual Memberships for the Jewelers Suite are $159 per year. Please ensure that all of your questions are answered before signing up for the association. Association membership fees are non-refundable, unless you are not accepted into the plan.

Q: Is this a traditional, fully-funded insurance plan? 

A: The APEX Advantage Plan is not a traditional, fully-funded insurance product.  It is a plan that we have created specifically for the jewelry and pawn industry, which offers comprehensive benefits to Jewelers Suite members, who are eligible to participate.

Q:  What is my deductible for this plan?

A:  This plan provides first dollar coverage, so you have no deductibles to meet.

Q:  I am an employer who needs to offer insurance coverage to my employees.  Is the APEX Advantage plan ACA Compliant?

A:  Yes.  To be clear, the Affordable Care Act does not require businesses to provide health benefits to their workers, but applicable large employers may face penalties if they don’t make affordable coverage available. The employer shared responsibility provision of the Affordable Care Act penalizes employers who either do not offer coverage or do not offer coverage that meets minimum value and affordability standards. These penalties apply to firms with 50 or more full-time equivalent employees.  If you have more than 50 full-time equivalent employees, this plan meets the requirements for your company to provide ACA Compliant health insurance.

Q: Will I receive an ID Card? 

A: Yes, An ID card and welcome kit will be sent to your home address. The ID card is generally delivered a few days after your requested effective date. 

Q: I need an affordable, yet comprehensive plan for my family. A plan that will address my day-today health care needs. Can the APEX Advantage Plan address these things for me?

 A: Yes, it will address the bulk of your day-to-day health care by frequency. The most common health care needs are for Preventive Care, Primary Care, Specialists, Urgent Care, Laboratory, Imaging and Prescription Drugs. By frequency this accounts for almost 90% of health care service provided and the Advantage Plan provides benefits with small copayments and 100% coverage for those services. 

Q: It covers prescriptions, can you tell me a little more? 

A: The Advantage Plan provides a 6 tier prescription drug benefit with an emphasis on Generic Medications. A Tier 1 , Low Cost Generic is only a $1 Copay. Tier 2 Generics, 10% coinsurance. There is a sliding scale for coverage on Tiers 3 – 6.

Q: Does this plan cover Preventive Care Services?

A:  Yes, the plan provides 100% benefits with no copays, and no deductibles for the following Preventive Care services as defined by the Affordable Care Act (ACA): • 21 Preventive Care services for Adults • 28 Preventive Care services for Women • 31 Preventive Care services for children 

Q: Is there a network of doctors or physicians ?

A: Yes.  The Multiplan/PHCS network of doctors, hospitals and other healthcare providers that are offered through this plan are exactly the same ones that every major insurance company, including Aetna, United Healthcare and the Blue Cross companies, use for their policyholders, since it provides access to close to 900,000 medical providers around the country.  And, the good news for you, APEX also uses this network for your plan and the 100,000 members of their other Association-type clients.
There is no coverage for out-of-network services.

Q:  Does this plan include surgical and hospital benefits?

A:  Yes.  The ManhattanLife Affordable Choice portion, which is part #2 of the plan, covers the surgical and hospitalization benefits.  There is a $1,000,000 ($1 million) dollar cap on this part per patient, per year, and a $5,000,000 ($5 million) dollar lifetime maximum. Please note –  If you have been diagnosed with a serious illness that has required hospitalization in the last 12 months, please double check to make sure the coverage you need is available under the ManhattanLife Affordable Choice portion of the plan.

Q:  Is there a yearly cap on the surgical and hospitalization benefits, or a lifetime maximum benefit payout for this plan?

A:  Yes.  There is a yearly cap on surgical and hospitalization benefits of $1,000,000 (one million dollars), and a lifetime maximum benefit payout per patient is $5,000,000, (five million dollars).

Q:  If my employer insures me under this plan and I leave my job, can I take the plan with me?

A:  Yes.  The plan is fully portable, and is issued in the name of the individual, not the name of a company.  While the company may pay the benefits for you as long as you are in their employ, if you leave, this plan can move with you, although you would then be responsible to keep paying for the benefits.  This means you and your family would still be insured, and don’t have to worry about paying excessive rates for health insurance through COBRA while you are in between jobs, and your coverage remains continuous.

Q:  Do I have to go through medical underwriting to qualify for this plan?

A:  Yes.  Our plan has two parts, the APEX side and the Manhattan Life side.  There is no medical underwriting necessary on the APEX side, however, there is medical underwriting on the major medical Manhattan Life side of the plan.

Q:  Are there certain conditions that are excluded from coverage?

A:  Yes.  There are a few conditions that are excluded from coverage on this plan, but we encourage you to contact us for more information, since we have several additional health plan coverage options available for those who are higher risk on the health care insurance side.

Q:  Is there a waiting period for eligibility?

A:  Not unless you need to have follow up from underwriting.  In most cases, if you apply for plan coverage by the 20th of any month, your plan will become effective on the 1st of the following month.

Q:  What happens if my current health plan expires before the January 1, 2020 effective date on the Health Plans for Jewelers option?

A:  Don’t worry!  Although it might appear from the way you are reading your plan that if you renew with your current provider you will be locked in for another year, this simply isn’t the case.  You can change your health care provider at any time during the life of your policy.  So if you are one of the many whose policies will be expiring between now and December 15, you can simply let your policy renew to keep the status quo, and then change it over as soon as the holiday rush is behind you.

Q:  Does this plan include a maternity health coverage option? 

A:  While the APEX plan is designed to cover 90% of healthcare services with small copayments, it does not offer a maternity component.  HOWEVER, we have sourced a health coverage option for maternity that you can add on to this plan if necessary, for an additional monthly fee.  Details and costs on that maternity coverage will be posted within the next week.

Q:  Does this plan offer a vision and dental component?

A:  Yes, we have sourced an excellent add-on plan that offers dental, vision and hearing insurance options for you.  These plans have two levels of coverage to choose from, offer competitive rates, and guaranteed coverage up to age 85.  Find more information about our dental, vision and hearing plan options HERE

Q:  I’m still having trouble figuring out if my providers will be covered under this plan.  Can you help me with that?

A:  Yes, of course!  You can easily search for providers that will be covered under this network online at: https://www.multiplan.com/webcenter/portal/ProviderSearch   If you are having trouble finding the provider you are looking for, please email Ann@HealthPlansforJewelers.com for additional assistance.

Q:  How can I find out if the pharmacy I am currently using will be available through this new plan? 

A:  The prescription portion of our plan will be administered by Citizens RX. Citizens Rx provides excellence coupled with unmatched flexibility to meet unique member needs. The Citizens Rx Network Pharmacy embraces Independent Pharmacies, Regional Chains, National Chains, Big Box and Grocery Stores, Mail Order Pharmacies and Custom Networks consisting the largest network nationwide over 67.000 pharmacies. If you want to make sure your pharmacy is part of the Citizens Rx network, give them a call and ask.  If you still have questions, please email Ann@HealthPlansforJewelers.com for more help.

Q:  I am over 65 and don’t see a tier for 65+ health care coverage listed on this plan.  Can I still get insurance through this plan?

A:  As of right now, the plan we are offering covers individuals up through age 65.  If you are over 65, and in need of health care coverage, please email Ann@HealthPlansforJewelers.com so we can set you up with Jonathan Johnson in the next few weeks for a health care needs consultation.

Q:  Is there an open enrollment date on the Health Plans for Jewelers policies, or can I sign up any time of the year?

A:  There is no fixed date that you have to elect our benefits program.  You can sign up at any time during the year.  As long as you enroll in the program before the 20th of the month, your coverage will begin the 1st of the following month.

Q:  I pay health insurance for my children, but they don’t live with me.  Can I still include them on my health care policy?

A:  Yes.  As long as they are your children, you can include them for coverage on your family policy.

Q:  I would like to cover my significant other on my health care policy, but we are not married.  Can I cover them under my plan?

A.  No.  Coverage is only available on a family policy for married couples.  However, any member of the Jewelers Suite has the option to elect a separate, individual policy under this plan, so they can secure coverage that way.

Q:  I want to make sure that the doctor or facility I use is covered under this plan, but I can’t seem to find them on the provider search.  How can I confirm they are on the plan?

A:  Many providers and facilities provide their services under one name, but may be credentialed under another.  If you have questions as to whether or not your provider or facility is part of the Multiplan network, you can either call the doctor or facility directly and ask them if they participate in the Multiplan network, or email Ann Glynn at Ann@HealthPlansForJewelers.com for next level help with the provider and facility search.

Q:  Can I call my doctor’s office to find out if they are covered under this plan?

A:  Yes!  Just contact your provider of choice and ask them if they are part of the MultiPlan Network.  Please use the words “MultiPlan” network – as that refers to the network our benefits is affiliated with.

Q:  I’ve contacted my provider and it doesn’t appear they are listed on the Multiplan Network.  Is there a way to get them on the Multiplan Network?

A:  Yes!  Although the multiplan network has more than 770,000 service providers registered, there is always a chance that your provider of choice might not yet be on the Multiplan network.  If you have searched for your provider, and don’t see them listed in the network, you can always nominate a provider.  It’s quick and easy!  To nominate your provider of choice, please visit: https://www.multiplan.com/nominate/nominate.cfm?type=patient&originatorid=84367

Q:  I love the plan and the benefits.  How do I sign up?

A:  The Health Plan for Jewelers insurance benefits were created for members of the Jewelers Suite.   All of the Jewelers Suite benefits are available to every segment of the jewelry and pawn industries, including retail, wholesale, sales representatives and service support vendors, watchmakers, bench jewelers, consultants, pawnshop owners, jewelry designers and specialty shops.  Individual Memberships for the Jewelers Suite are $159 per year. Please ensure that all of your questions are answered before signing up for the association. Association membership fees are non-refundable, unless you are not accepted into the plan.