About
Alliance Secondary HealthWhat is Alliance?
Alliance Secondary Health is a product that complements a comprehensive major medical plan with a supplemental health insurance product that is administered by United Group Programs, Inc. under the brand name OptiMed. This product can be customized to work in conjunction with any primary health insurance provider in the marketplace. Alliance Secondary Health is not a replacement for your primary coverage, but rather a supplement to your primary carrier’s health plan. Simply put, Alliance Secondary Health pays the member’s portion of an eligible medical claim (i.e., copays, deductibles, and coinsurance) up to the annual maximum benefit. Benefits may be directed to the healthcare providers upon submission of the patient’s Itemized Bill or HCFA and the Primary Carrier’s EOB.
Alliance Secondary Health is one of the few benefits that an employer can provide, which is universally beneficial. When implemented with the help of an Alliance consultant, your organization’s overall health insurance premiums should decrease and your employees will experience a reduction in their out-of-pocket expenses.
The products offered by Alliance Secondary Health also provide numerous advantages by helping employers reduce single and family rates. Alliance is also helping employers achieve premium stability by allowing greater flexibility when picking a primary insurance plan design and by reducing the company’s claims experience with their primary provider.
Frequently Asked Questions
What is Alliance Secondary Health?
Alliance Secondary Health product is a supplemental health insurance product. It pays the member’s portion of an eligible medical event, in which the primary insurance carrier does not cover (i.e., copays, deductibles, and coinsurance) up to a predetermined amount per calendar year, and subject to the policy limitations and exclusions.
What is an eligible medical event?
The determination of a qualified medical event, is based on your primary carrier’s definition of an eligible medical expense. In other words, if the primary provider deems the medical procedure or service to be a covered charge, then Alliance Secondary Health will also deem it a covered charge, that is eligible for benefits. Covered charges under the supplemental health insurance product are limited to the deductible, copayment and coinsurance amount the insured person is required to pay under the major medical plan (the supplemental plan excludes coverage for Preventative Care, Mental/Nervous conditions, Prescriptions and certain other limitations).
Who files and pays the claims?
The medical providers have the ability to file all of the claims. Members simply have an additional supplemental insurance card that allows providers to file claims on their behalf and be paid directly by the insurance company, or benefits may be paid directly to the member.
Is Alliance Secondary Health intended to replace my current health plan or provider?
No. It is NOT intended to replace your current provider or health plan, but rather it works in conjunction with any plan or provider in the marketplace.
Does Alliance Secondary Health have a restrictive network?
No. An open network without network limitations is utilized with Alliance Secondary Health but is not affiliated with the supplemental health insurance product or its underwriters.
How is Alliance Secondary Health affected by the PPACA (||Obamacare||)?
By adding supplemental health insurance, Alliance Secondary Health gives companies the ability to improve their overall plans while reducing major medical premiums and claims experience.
Will Alliance Secondary Health increase the cost of our health insurance?
No. Even with the additional Alliance Secondary Health premium, your overall health premiums should go DOWN!
Are preexisting conditions excluded?
No. However, covered charges must be payable under both the supplemental plan and the insured’s major medical plan.
Who administers Alliance Secondary Health?
Alliance Secondary Health is administered by United Group Programs, Inc. under the brand name OptiMed. FSL has been rated A- (Excellent), based on an analysis of financial position and operating performance, by A.M. Best Company, and independent analyst of the insurance industry. For the latest rating, access www.ambest.com.
What is needed for an initial analysis?
(1) Current Summary of Plan Description;
(2) Current rates;
(3) Census of employees on your plan;
(4) Amount of HSA, HRA, or FSA employer contributions (if any);
(5) A meeting with an Alliance consultant.