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MDA Health Plan for Dental Offices

Health insurance seminars:
‘Health Care Reform 2.0: Uncertain Times’

REGISTER NOW>   When it comes to choosing your health insurance plan for 2018, the only thing you can be certain of is uncertainty. But don’t fear. MDA Insurance will fill you in on what you need to know and what changes may be in store. At press time, the House of Representatives had passed a bill to repeal and replace the Affordable Care Act. The Senate bill may differ significantly. Each have many provisions that could impact MDA members. MDA Insurance will fill you in on what you need to know and what changes may be in store. Please plan to attend one of the three-hour health plan seminars listed to stay up-to-date on the MDA Health Plan and other health insurance news. You’ll want this information to be prepared for Open Enrollment in the MDA Health Plan, which begins Oct. 1 and concludes Nov. 15.  Time will be alloted for questions and answers and you will earn three FREE CE credits are available for attending. Space is limited so please secure your seats early.

Choose one of the following seminar dates:

  • Friday, Nov. 10: Troy: Detroit Troy Marriott, 200 W. Big Beaver Rd., 48084, 9 a.m.-Noon
  • Friday, Nov. 17: Saginaw: Four Points by Sheraton, 4960 Towne Centere Rd., 48604,  9 a.m.-Noon

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This seminar will cover:
• The MDA Health Plan
• ACA-related updates
• What to expect from the individual health insurance market
• How insured small group plans are evolving
• Impact on the Marketplace and subsidies

Please note, this program will not address Medicare or Medicare-related health plans. For a listing ofupcoming Medicare-specific seminars, or to schedule a meeting with Rick Seely of our Medicare advisory team, please call Denise Wyzywany 877-906-9924, ext. 450, or email denise@mdaifg.com.

 

Understanding the MDA Health Plan

 

 

 

 

 


 

 

 

 

The MDA Health Plan is available exclusively to members of the Michigan Dental Association and their employees. This is an employer-sponsored group health plan organized as a self-insured multiple employer welfare arrangement (MEWA). The dentist, as the employer, sets the eligibility rules for employees to participate in the MDA Health Plan. Each employer retains the right to determine:

  • How many hours per week an employee must work to be eligible for the plan, with a minimum requirement of 24 hours per week*.
  • Whether to include the employee's spouse and/or child(ren) in the plan.
  • Whether to contribute toward the cost of the health plan on their employees' behalf. Contributions may be a percentage of the cost or a flat dollar amount. Employers may contribute to employee-only coverage, or to the cost of spouse/dependent coverage.

Employers may not discriminate in providing coverage or in contribution levels.

*Employers of 50 or more full-time equivalent employees must allow participaton at 30 hours of work per week, in accordance with the Affordable Care Act.

Rates will be developed based on the census of the office.

  • There are 4 geographic rating areas
  • Each subscriber on the policy has his/her own rate by age in 5-year age bands
  • Each child under 19 has his/her own rate, up to a maximum of 3 children per family
  • Rates are added together to produce an aggregate for the office

Enrollment additions and deletions

To ensure proper coverage and billing, please be sure to report enrollment changes such as new eligible employees, newborns, divorces and employee terminations to us immediately. Please use the Enrollment Change Form, available at left, to submit new subscribers or delete employees who are no longer eligible or who leave your employment. Changes must be reported within 30 days.

EaseCentral Online Administration Registration Form

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Plan Designs

Six plan designs are available. One health plan may be selected for offices with nine or fewer employees enrolled. An office with 10 or more subscribers enrolled in the plan may choose two health plans.

In the chart below, the SBC is the Summary of Benefits and Coverage. The BAAG is the plan's Benefits-at-a-Glance. Click on the acronyms to download the PDF and view the information.

Preferred Provider Organization (PPO) Plans

In-Network Amounts
Plan Name Deductible Co-Pay Total Out-of-Pocket
Plan 1
SBC
BAAG

$500 Single/ $1,000 Two-Person/ $1,500 Family

Prescriptions: $10 generic/ $40 preferred/ $80 brand  / 20% preferred specialty ($200 max)

$30 Office Visit
$60 Specialist
$35 Urgent Care
$100 E.R.
20% coinsurance

$4,000/ $8,000/$12,000

Plan 2
SBC
BAAG

$1,000 Single/ $2,000 Two-Person/ $3,000 Family

Prescriptions: $10 generic/ $40 preferred/ $80 brand  / 20% preferred specialty ($200 max)

$7,150/ $12,500/ $14,300

Plan 3
SBC
BAAG

 

$1,500 Single/ $3,000 Two-Person/ $4,500 Family

Prescriptions: $10 generic/ $50 preferred/ $100 brand  / 20% preferred specialty (200 max)

$35 Office Visit
$70 Specialist
$35 Urgent Care
$100 E. R.
20% coinsurance

$7,150/ $12,500/ $14,300

Plan 4
SBC
BAAG

$2,500 Single/ $5,000 Two-Person/ $7,500 Family

Prescriptions: $10 generic/ $50 preferred/ $100 brand  / 20% preferred specialty ($200 max)

$7,150/ $12,500/ $14,300

Plan 8
SBC

BAAG

$3,000 Single/ $4,500 Two-Person/ $6,000 Family

Prescriptions: $10 generic / 50% preferred brand (max $100) / 50% non-preferred brand (max $300) / 20% preferred specialty ($200 max)  / 50% non-preferred specialty ($400 max)

$30 Office Visit
$60 Specialist
$50 Urgent Care
$100 E. R.
20% coinsurance

$7,150/ $12,500/ $14,300

Plan 10
SBC
BAAG

$7,150 Single/ $12,500 Two-Person/ $14,300 Family

Prescriptions: $10 generic / 50% preferred brand (max $100) / 50% non-preferred brand (max $300) / 20% preferred specialty ($200 max)  / 50% non-preferred specialty ($400 max)

$35 Office Visit
$70 Specialist
100% E.R. after deductible
$50 Urgent Care

$7,150/ $12,500/ $14,300


The plans below are qualified for health savings accounts (HSA). Fund your HSA with pre-tax dollars to reduce your taxable income and pay for eligible medical and vision expenses. Unexpended funds accrue from year to year and can be used to pay for health care in retirement.

High-Deductible/HSA Health Plans 

In-Network Amounts
Plan Name Deductible Co-Pay Total Out-of-Pocket
Plan 5
SBC
BAAG

$2,000 Single
$4,000 family

20% coinsurance
Prescriptions: $10 generic/ $50 preferred/ $100 non-preferred brand
20% specialty ($200 max)
 

$5,000 Single
$10,000 Family
 

Plan 6
SBC
BAAG

$3,000 Single
$6,000 family

20% coinsurance
Prescriptions: $10 generic/ $50 preferred/ $100 non-preferred brand
20% specialty ($200 max)

$6,450 Single
$12,900 Family

Plan 9
SBC
BAAG

$4,000 Single
$8,000 family

20% coinsurance
Prescriptions: $10 generic/ $50 preferred/ $100 non-preferred brand
20% specialty ($200 max)

$6,550 Single
$13,100 Family

 

 

Exclusive Provider Organization (areas 1 and 3 only)

In-Network Amounts
Plan Name Deductible Co-Pay Total Out-of-Pocket
Plan 7
SBC
BAAG

$2,000 Single
$4,000 Two-Person
$6,000 family

20% coinsurance
Prescriptions: $10 generic/ 50% preferred  (max $100) / 50% non-preferred brand (max $300) / 20% specialty ($200 max)

$4,000 Single
$6,000 Two-Person
$8,000 Family
 


Access our Frequently Asked Questions guide about Health Savings Accounts.

View informative videos about Health Savings Accounts. Note: MDA Insurance does not endorse any financial instituation for Health Savings Accounts.

All MDA Health Plan designs are powered by Priority Health. Participating providers and facilities are part of the multi-tier networks used by Priority Health. Claims are administed on behalf of the MDA Health Plan by Priority Health. MDA Insurance can provide assistance with any claim questions or subscriber service needs. 

Subscriber Service Contact Information:
MDA Insurance: 877.906.9924 Mon.- Fri. 8 a.m. - 5 p.m.
Prioirty Health: 800.956.1954 Mon. - Thurs.  7:30 a.m. - 7 p.m.; Fri. 9 a.m. to 5 p.m., Sat. 8:30 a.m. to 12 Noon

Plan Documents

Various regulations require the documents below to be made available to MDA Health Plan sponsors and employees. Documents may be downloaded and saved or printed. Adobe Acrobat Reader is required to access these documents. You may access a free download of Acrobat Reader by clicking here.

PPO Plans

Summary Plan Description for Plans 1-4, 8, and 10
Schedule of Medical Benefits

High-deductible Health Plans (HSA)

Summary Plan Description for Plans 5, 6 and 9
Schedule of Medical Benefits

Exclusive Provider Organization (EPO)

Summary Plan Description for Plan 7
Schedule of Medical Benefits

Want Vision Insurance?

MDA Insurance offers your choice of insured vision plans on a stand-alone basis. Plans are billed quarterly on an individual basis. For information on vision insurance plans and rates, please click here

Employer Financial Obligation Notice

The members who participate in the self-insured MDA Health Plan ultimately are responsible for paying claims. The state of Michigan requires language to be included in the participation agreement that states members understand they could be assessed up to four months of contributions to cover shortfalls if necessary.

  •  If the employer ceases to participate in the MDA Health Plan, it continues to be liable to the health plan trust for its proportionate share of any assessment made by the Michigan Insurance Commission for benefits paid during the previous calendar year.
  • If the cash reserves of the Trust and Plan are less than required by Michigan, participating employers will be liable for up to four months of contingent premiums should the plan's Trustees demand it during the time the employer participates in the plan and for the one-year period after participation in the plan terminates.
  • While this possibility exists, it is remote. The MDA Health Plan is using an actuary to project claims based on historic and anticipated utilization. The state of Michigan reviews and actuarial analysis for reasonableness and accuracy. These actuarial projects of plan expenses are used to build the rates to provide adequate contributions from members.
  • Another factor that makes it unlikely that an assessment would be required is MDA Insurance's 30-plus years of successfully administering its individual health plan, which required the negotiation of rates to ensure the adequate collection of funds to cover claims.

 

Required forms

To obtain a quote, both the Census form and the Participation and Business Rules document must be submitted to us. Please be sure to download and complete them both and return them to us. Additionally, each employee who wishes to be quoted must complete and submit a Health Plan Questionnaire, below.

  1. Census Form to obtain a quote. Please follow the directions on the cover page and submit the completed census and the Participation and Business Rules document to MDA Insurance via fax at 517.484.5460.
  2. Participation and Business Rules document. You will also need this form to obtain a quote.
  3. Health Plan Questionnaire. Each employee, including the employer, who wishes to be quoted for benefits must complete and return this document.

Enrollment Change / Change of Status Form for address or name changes, adding a newborn, deleting dependents or terminating coverage for active subscribers.

New Hire Enrollment Form to enroll employess in practices offering one MDA Health Plan option.

Waiver of Coverage Form to document that an employee opts to waive participation in your group health plan.

Tax-Advantaged Premium Payment Plans

The monthly invoice for your office's participation in the MDA Health Plan must be paid by the employer only. Employers may payroll-deduct their employees' share of the cost of the health plan. By offering a Premium Only Plan (POP), employees can make their contribution on a pre-tax basis, reducing their taxable income and reducing your practice's payroll taxes. 

A POP can be established using BASIC, which the MDA endorses for payroll services. For information on establishing a POP for your practice, click here or call BASIC at 800.444.1922. Special prices are in effect through Dec. 31, 2014.

Priority Health Links

The MDA Health Plan is powered by Priority Health and uses the Priority Health provider networks. Prioirty Health brings many new services to our subscribers. Click the links below to learn more.

Find a Provider Using the Priority Health Network Map (interactive): Use this to search for your providers. The network names are hyperlinks to search sites.
Complete Approved Drug Formulary: For MDA Health Plan members
Commonly Prescribed Approved Drug List: Print and take with you to appointments.
Prescription Drug Prior Authorization From: For step-therapy drugs
Approved HSA Preventative Drug List: Paid prior to deductible for high-deductible health plan subscribers (Plan 6). For drug coverage call Priority Health at 800-956-1954.
Medical Case Management: For help with chronic conditions and serious illnesses
Assist America Global Emergency Service: Travel and medical assistance when 100 miles or more from home. Learn about Assist America (member log-in required)
Virtual Visits: Get care for minor illnesses virtually (member log-in required)!
Health Care Blue Book: Learn the cost of care before you obtain it (member log-in required)
Access to Discounted Products and Services: Save on gym memberships, computers, water treatment systems and more (member log-in required)
Member Account Online: Create your personal Priority Health portal
Video on How to Use the Member Site: Learn to use the member site (member log-in required)
Using Your Mobile Account: Smartphone app access to your health plan account (member log-in required)
Health Savings Account Calculator: Estimate your health care-related expenses to fund your HSA (member log-in required)
Downloadable HSA Book: Learn about HSAs
HSA Frequently Asked Questions: Info you need to know
Preventive Care Guidelines: To help you know what preventive care is available and why to take advantage of it.

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