Find answers fast to our Frequently Asked Questions
Q: I heard there is an injunction in 8 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: Is this a traditional, fully-funded insurance plan?
A: The BRECKPOINT Advantage Plan is not a traditional, fully-funded insurance product. It is a plan that we have created specifically for the HEALTH PLANS FOR JEWELERS, which offers comprehensive benefits to HEALTH PLANS FOR JEWELERS 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 BRECKPOINT 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, 2 ID cards, welcome kit, and policy will be sent to your home address. The ID cards are generally delivered a few days after your requested effective date. There will be 1 ID card for the BRECKPOINT portion; which include office visits, preventative medicine, and prescription coverage. There will be 1 ID card for Manhattan Life portion; which include surgical and hospital coverage. These cards will arrive in separate envelopes.
Q: I need an affordable, yet comprehensive plan for my family. A plan that will address my day-today health care needs. Can the BRECKPOINT 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: 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 First Health 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, Breckpoint 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 Breckpoint side and the Manhattan Life side. There is no medical underwriting necessary on the Breckpoint 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: Does this plan include a maternity health coverage option?
A: While the Breckpoint plan is designed to cover 90% of healthcare services with small copayments, it only offers limited maternity office visit benefits. HOWEVER, we have sourced a health coverage option for other maternity costs that you can add on to this plan if necessary, for an additional monthly fee. Details and costs on that maternity coverage are available upon request.
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 seHealth Plans for Jewelersh for providers that will be covered under this network online at www.firsthealthlbp.com
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 Shield. Shield provides excellence coupled with unmatched flexibility to meet unique member needs. The Shield 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 Shield network, give them a call and ask.
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.
Q: Is there an open enrollment date on the HEALTH PLANS FOR JEWELERS health plan 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 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 seHealth Plans for Jewelersh. 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 First Health network, you can call the doctor or facility directly and ask them if they participate in the First Health network.
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 First Health Network. Please use the words “First Health” 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 First Health Network. Is there a way to get them on the First Health Network?
A: Yes! Although the First Health 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 First Health network. If you have seHealth Plans for Jewelershed 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.First Health.com/nominate/nominate.cfm?type=patient&originatorid=84367