HMA Group Plan Solution Frequently Asked Questions

Overview of the HMA Group Plan Solution

Who is the "HMA" in the HMA Group Plan Solution?

Hawaii Mainland Administrators, LLC in Tempe, Arizona provide Third Party Administration service for the Apex HMA Healthcare Solution.

Why should an Employer consider the HMA Group Plan Solution?

Employers who are in a very competitive employee recruiting and retaining environment should consider the Apex HMA Group Plan Solution.  With the HMA Group Plan Solution, in addition to providing your employees access to an expansive network of Physicians through the PHCS Network, they also receive instant access to valuable services though a robust mobile app called Health Wallet.    

For only an additional $4 per month per participant, employees have on demand access to a robust mobile app called Health Wallet.  Health Wallet provides direct access to providers and services such as:

  • Text a Health Expert - Immediate and unlimited access to network of medical experts who are standing by via text waiting to lend their instant advise and medical opinions for those times when texting is the only option.
  • Rx Market - Search for any prescription to see what the pharmacies around
    you are charging for the drug. Rx Market has an embedded
    manufacturers discount code
  • Medical Market - search for anything from an allergy shot to
    cardiovascular bypass using the current location of your mobile
    device, and see what different facilities are charging
  • My Plan Info - A centralized location with current health plan information, realtime
    utilization and capacity to hold ID Cards
  • User Engagement - Receive important reminders about plan updates, changes,
    feature updates and tips on how to access cost‐effective and
    convenient health care whenever you need it

The addition of these valuable services could make the difference in employee recruitment and retention.

What are the best target industries for selling this health care solution?

General FAQ's Regarding HMA Solution

Is this plan ACA (Affordable Care Act) compliant?

Yes. The Apex Suite of MEC products comply with all applicable rules and regulations pertaining to Penalty A of the ACA.  See compliance opinion letter under the "About" tab on the website.

Why choose the Apex Suite of MEC Products?

The Apex MEC Suite of Products are designed to expand the benefit above what is mandated by the ACA. In particular, the MEC Plus Advantage Plan offers three (3) Primary Care visits and three (3) Specialist visits; Diagnostic; Urgent Care and a six (6) tier prescription drug card program through our partner WellDyneRx. 

When is payment due and what is required for eligibility?

Eligibility is determined by the payroll feed delivered to our TPA on or before the 25th of each month.  Payment is due by the 15th of the month.

Is there an employee minimum with the Apex HMA Solution?

The Apex HMA Solution is an employer sponsored plan with a minimum of four (4) employees participating and is completely voluntary with no underwriting.

Can all 4 plans be offered to an employer?

No, only 2 (two) plans can be offered per employer.

Do the Apex plans have a Physician network to choose from? 

Yes, the Apex plans provide access to Preferred Health Care Services (PHCS),one of the largest physician networks in the country.  PHCS is owned by MultiPlan, Inc. and has over 900,000 physicians nationwide.  The Apex plans do not provide coverage for out-of-network services.

 

What other benefits are included with the Apex HMA Solution?

The Apex HMA Group Plan Solution includes Teladoc.  Teladoc is a national network of U.S. board-certified physicians and pediatricians that lets you resolve your routine medical issues, on-demand 24/7, via phone or online video consultations from wherever you happen to be.  Teladoc Doctors can prescribe medical treatment for a wide range of conditions right over the phone or through a mobile app.  To learn more about the benefits of Teladoc go to https://www.teladoc.com/

Are Apex Group Plan Solutions fully-insured or self-insured?

The Apex Group Plan Solutions are self-insured. Apex Management Group offers, through a self-funded model, a four (4) year rate lock at a static premium level. However, Apex reserves the right to increase pricing on an annual basis no greater than 3% based on an individual client identified “loss ratio.”

Are preventative services covered?

Yes. Coverage is provided for all mandated Preventative benefits required by the PPACA.

  • All 21 Preventative Services for Adults
  • All 28 Preventative Services for Women
  • All 31 Preventative Services for Children

A complete list is available at www.healthcare.gov/center/regulations/prevention.html

Are COBRA services included in Apex plans?

Yes, Cobra services are included with the Apex Management Group plans?