Medical FAQ
Q. What health plans are available to member firms?
A. Groups of 2-9 eligible employees may offer up to two medical options, one from each product line (PPO vs. HMO/POS).
Groups with 10-99 eligible employees can select a maximum of three medical plans with no more than two from each product line (PPO vs. HMO/POS) and a maximum of two prescription drug plan options.
Q. Are pre-existing conditions covered under the AIA Association Plan?
A. Yes, all pre-existing conditions are covered under the AIA Association Plan. There are no limitations for pre-existing conditions.
Q. I am a sole practitioner with no employees. How can I acquire coverage for myself and/or my family?
A. As long as you are a licensed Architect, have a valid PA registration and can prove you earn a living as an Architect, you may enroll as a one person group. When you submit your master application form, you must enclose a copy of your license and your most recent Schedule C.
If you are not a licensed architect, you may elect to enroll in one of three plans, either the PC Prime Option, the Keystone HMO Copay 3 Facility 4 with $20/$40/$60 prescription drug plan or the PC HDHP plan HD2HC1 with prescription drug. Please contact Kristen Garry at 267.794.3010 or for more information.
Q. I have both full time and part time employees. What are my requirements for covering them?
A. For groups with 2 to 19 employees, 100% of all eligible employees must be enrolled in Independence Blue Cross programs. IBC will require two minimum enrolled lives and will count waivers who are not covered elsewhere in the eligibility calculation. For groups with 20 to 99 employees, at least 75% of all eligible employees must be enrolled in IBC programs and will count waivers who are not covered elsewhere in the eligibility calculation. You can elect to cover part time employees who work 20 hours or more per week, but you must be consistent in offering the benefits to all employees in that category. You must indicate your criteria on the master application form.
If any eligible employee has coverage elsewhere and elects to waive coverage, they must complete a Small Employer Health Benefits Waiver of Coverage Form. Please contact Gallagher Benefit Services, Inc. to get an original of this form. This verification must be submitted with the master application.
Q. What happens to my coverage once I become eligible for Medicare?
A. If you are covered by a group policy and are still considered an employee, you can continue your group coverage. It is important to enroll in Medicare Parts A, B and D when eligible; however, enrollment in Part D is based on your current prescription drug coverage. There are Medicare Supplement policies available from IBC if you live in Bucks, Chester, Delaware, Montgomery, or Philadelphia counties. If there is already a group Supplemental 65 plan in force you will be able to enroll in that plan.
Q. Our firm is an Affiliate Member. Can we join the plan?
A. Yes. The group must have two or more employees. If you are a sole proprietor, you must be a licensed architect or your only options will be the PC Prime Option, Keystone Copay 3 Facility 4 with $20/$40/$60 prescription drug plan or the PC HDHP HD2HC1 with prescription drug plan.
Q. Up to what ages are dependents covered?
A. Dependents are covered up to age 19 or 23, if enrolled full time as a student in an accredited educational institution. If you are enrolled in the sole proprietor plan PC Prime, dependents are only covered to age 19, regardless of being a full time student or not. At the time of enrollment, you will need to submit proof of full time student status from an accredited college or university. Additionally, twice during the year, IBC will verify student status via a national database. If they can't verify a dependent, a letter will be sent out requesting that verification be made. At the end of the month in which a dependent reaches age 23, he/she will automatically be removed from the group plan.
Q. How long are the rates quoted for good?
A. If your policy was written prior to August 15, 2008, your rates will renew every January 1st or 15th based on your billing cycle. If your policy was written on or after August 15, 2008, your rates will renew on the 1-year anniversary of the policy effective date. Rates are good for one year from the effective/renewal date.
Q. Are there any other costs associated with the plan other than the premium costs?
A. No. There are no additional charges for monthly billing. You must be a member in good standing with the Philadelphia Chapter of the AIA. Premium bills will be sent directly to your firm from Independence Blue Cross.
Q. How often can I change the plan offerings of my group plan?
A. You will have the opportunity to change your plans at Open Enrollment each year. Open Enrollment is the 1-year anniversary of when your policy was written. Open Enrollment is the time (other than within 31 days of a qualifying event) when employees can change plans or add and remove dependents.
Q. How do we enroll in the plan?
A. All original enrollment forms must be sent and received by Gallagher Benefit Services 20 calendar days prior to the effective date of the group plan. All effective dates must be the first of each month. Any incomplete packets that are sent to Gallagher Benefit Services, Inc. may delay your effective date. Please make sure that you have completed all the necessary information.
Mail all original forms back to:
Gallagher Benefit Services, Inc.
ATTN: Kristen Garry
115 West Avenue, Suite 115
Jenkintown, PA 19046
e-mail:
Q. How do I notify Independence Blue Cross of changes, additions of new employees or terminations?
A. To send information to IBC regarding a Personal Choice policy, complete the Personal Choice Enrollment Report (#4 on the forms page of this website). If adding a new employee, they will also need to complete the Employee Enrollment form (#3 on the forms page of this website).
To send information to IBC regarding a Keystone policy, complete the Keystone Transmittal form (#7 on the forms page of this website). If adding a new employee, they will also need to complete the Employee Enrollment form (#3 on the forms page of this website).
If you have provided Gallagher Benefit Services with authorization to process changes, additions of new employees or terminations, you can fax the necessary forms to Kristen Garry at 215.884.8055. To authorize Gallagher Benefit Services to administer changes, additions and terminations, complete on your company letterhead the IBXpress Authorization form (#15 on the forms page of this website.
Q. How can I submit employee/dependent changes, additions, and/or terminations electronically?
A. Log on to www.ibxpress.com and sign up for the Group Access. Click on Group Log In, then Request for Access. Enter the requested information and your user ID and password will automatically be sent to you. They will be sent separately for security reasons. If you would like Gallagher Benefit Services to administer changes, additions and terminations of employees, fax the completed IBXpress Authorization Form (#15 on the forms page of this website) on your company letterhead to Kristen Garry at 215.884.8055.