Group Medical Plan FAQ
Who is eligible to join the plan?
Independent consultants and sole proprietors in Patina Nation are eligible to apply to this group medical plan. You must be actively at work on a full-time basis (work an average of 30 or more hours a week) and not be Medicare eligible.
How do I (we) apply for coverage?
The application process is fully automated. Applications are accepted until the 17th of the month prior to effective date of coverage. Enrollment is open every month, year-round.
Is everyone accepted into the plan?
No, there is an approval process. This is a preferred risk pool. All primary insureds and the dependents they wish to cover need to be reasonably healthy to be accepted into the plan.
How does the group medical plan year run?
The plan runs on a calendar year basis. Rate renewal occurs January 1 of each year. Applicants can enroll year-round, once qualified.
What have the historical rate increases been?
Renewal increases over the last 10 years have been in the 5 to 9% range per year depending on the plan design.
How is the program priced? Will I pay more if I am older?
This plan is composite priced, which means the rates for individuals of all ages and within all states are the same. There is no smoker surcharge. There is tiered pricing based on whether you choose to cover dependents.
What network of hospitals and doctors can we use in this plan?
There is a national network of providers you could access. See enrollment dashboard for details: https://eliteenroll.com/patina
How do I see the specific details of the available plans?
In the enrollment dashboard, you will have access to the provider networks, as well as a Summary of Benefits (SBC) for each plan.
If I am accepted into the plan, how do I pay the monthly costs?
The costs will be auto-drafted from your checking account each month. However, there is no cost to you to apply and no funds are drafted until you are approved for the plan. The auto-drafts take place between the 20th to 30th of each month prior to the start of coverage. A separate $20 association fee is also auto-drafted monthly.
Can I pay my plan costs with a credit card?
No, credit card payments are not accepted.
What coverage is available other than the medical plan?
Two dental plans, a vision plan, critical illness and accident coverage are also offered. All the information for these plans is on the enrollment dashboard.
Who should I contact with additional questions?
How do I find a doctor? Is my current doctor covered under these plan options?
The provider network search tool is on the enrollment dashboard. You can access this before you apply for coverage. Once you are an enrolled member this same info will be in your member portal.
How do I know if my prescriptions will be covered on this new plan?
There is access to the drug formulary on the enrollment portal as well as in the member dashboard.
Can I go to a regular pharmacy to fill my prescriptions?
Yes, the prescription plan is accepted at thousands of pharmacies around the country.
Will I receive a medical plan ID card in the mail?
Yes, you will be sent an ID card within 10 days of your effective date. You can access a temporary card on your effective date in the member dashboard.
What is the geographical coverage of the group medical plan options?
This plan is available in all 50 states.
What if something happens while I’m traveling?
If you are traveling in the U.S., you would have access to providers and facilities nationwide. These plans are PPO’s as such there is no need for a referral. If you travel outside of the U.S. and need emergency medical care, you will need to pay the charges out of your pocket. Upon return, we can request that the plan review the charges to see if they are eligible for reimbursement.
Do I need a physical exam before being approved for coverage?
What is the employee/member dashboard?
This portal grants access to an array of services and support, from selecting in-network physicians to securing new benefit cards, and more.
Do I have to pay any additional fees or dues to enroll in the group medical plan?
Monthly association fees are disclosed above. If you are approved for the group medical plan and decide to enroll, you will become a member of the union. Union dues are included in the monthly plan costs. If you terminate your group medical plan coverage your union membership will also terminate.
There is a one-time $75 enrollment fee, if you are accepted into the plan.
What is Elevate to Wellness?
Elevate to Wellness is the firm that offers the wellness benefits. Elevate built the enrollment system and benefits dashboard. They are responsible for enrollment and eligibility regarding the plan, as well as billing. To learn more about Elevate to Wellness, visit elevatetowellness.org.