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Our Innovative Benefit

Family Advantage
Health Plan

For the upcoming plan year, we are very excited to introduce an innovative benefit known as the Family Advantage Health Plan—or FAHP for short.

What is the FAHP?

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The FAHP is a voluntary health plan option that provides eligible employees and their family members the opportunity to have no deductibles, copays, or coinsurance for eligible out-of-pocket medical and pharmacy expenses. Effectively, creating a 100% health plan for those that enroll!

Benefits

Get to know your FAHP

Plan Benefits

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There are several benefits of the FAHP:

  • Reimbursement of any copays, deductibles, and coinsurance due on primary health insurance plan, up to the annual out-of-pocket maximums allowed by the Affordable Care Act. Effectively, this creates a 100% coverage plan for most participants enrolled in the FAHP.

  • No premium contribution deducted from employee’s paycheck to enroll in the FAHP.

  • Ongoing monthly payroll bonus per member enrolled in FAHP to help offset any additional premium costs of alternative employer coverage. See your employer for details.

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Eligibility Criteria

To be eligible, the member* (e.g. employee, spouse, and/or child) must meet two criteria:

  1. Member has been enrolled on the company medical plan for 12 months prior to the FAHP effective date. See your employer for specific details.*

  2. Member has access to enroll in alternative employer-sponsored medical plan (e.g. via spouse, parent, 2nd job, etc.). Alternative coverage DOES NOT include Medicare, Medicaid, Tricare, an Individual Policy, a Limited Benefit Health Plan, or any non-employer-sponsored insurance.

IRS Rules

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For any member of your family enrolled in the FAHP, it is important that you comply with important IRS rules:

  1. Members may be enrolled in a Health Reimbursement Account (HRA) or Flexible Spending Account (FSA). However, they cannot be reimbursed from both the FAHP and the HRA or FSA for the same claim (known as “double dipping”).

  2. Members may be enrolled in a Qualified High Deductible Health Plan that is compatible with a Health Savings Account as their primary medical coverage.  However, no  active contributions can be made to a Health Savings Account (HSA) while enrolled in the FAHP – including contributions from the employer providing the primary medical coverage.  

  • TIP: In situations where the employer providing the primary medical coverage includes an employer HSA contribution as part of the plan, it is best practice to:

    1. accept those contributions into a HSA account,

    2. withdraw them from the HSA at the end of the year to move to traditional checking/savings account,

    3. alert the HSA bank/provider that the withdrawal was due to an excess contribution for reporting purposes, and then

    4. claim the value of the contribution on your taxes as additional miscellaneous income so you pay taxes on the amount received since you were not truly HSA eligible.  This will allow you to still get some value from those employer funds without violating IRS regulations on that income.

Why FAHP

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We’re offering the Family Advantage Health Plan because it is a win-win-win benefit offering for you, your family, and the organization as a whole:

  • Better coverage for you and your family members when you need care.

  • Lower healthcare costs for your family.

  • More affordable costs for the organization, as the reimbursements for the FAHP are considerably less than the cost of primary insurance coverage.

Premium Payroll Bonus

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Your payroll bonus is calculated by the number of family members enrolled (including yourself, if also enrolled) in the FAHP, multiplied by a specific monthly amount to get to a monthly bonus amount earned (see employer for details.) This bonus is paid via standard payroll earnings and is considered taxable income. Payments start first period after your FAHP effective date.

Documents

Important Documents

FAHP Cost Comparison Worksheet

Complete this worksheet to learn real time costs for the FAHP vs. your current plan.

FAHP HRA Employee
Guide

Learn more about your FAHP HRA to help offset out-of-pocket expenses related to healthcare.

FAHP
Employee
Summary

All the information you need to understand the FAHP.

FAHP
Enrollment Affidavit

Waive coverage under your employer's group health plan and to participate in the FAHP.

FAHP
Enrollment
Change Term

Use this form to enroll, change or terminate your participation in the FAHP.

Enroll

Don't Miss Out! Learn How To Enroll.

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PRE-ENROLLMENT

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HOW TO ENROLL

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WHEN TO ENROLL

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POST ENROLLMENT

SUBMITTING CLAIMS

PRE-ENROLLMENT:

Submit questions, including the name of the organization you work for, to either of the following:

BCC will review your questions, compile answers and ensure you get informed either directly or through group education.

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HOW TO ENROLL:

If you are interested in the FAHP, here is what to do next:

  1. Verify eligibility for the FAHP with your HR department.

  2. Evaluate current coverage vs combination of other employer alternative coverage + FAHP. Use BCC Cost Comparison worksheet.

  3. Enroll applicable members in alternative employer coverage. Ensure no HSA dollars are received or contributed if the alternative employer coverage is an HDHP.

  4. Waive coverage from your employers medical plans for next year and complete the FAHP enrollment and attestation forms.

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WHEN TO ENROLL:

Eligible members may enroll in the FAHP:

  1. During annual open enrollment period, as long as other employer coverage has same open enrollment period or allows mid-year enrollment or

  2. Due to a qualifying event, such as spouse’s open enrollment or change in status (e.g. marriage, birth of child, etc.).

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POST-ENROLLMENT:

Advisors are available to assist you with your needs, including:

  • Filing or receiving claims reimbursements

  • Premium payroll bonus issues

  • Debit card questions

  • Anything related to FAHP Benefits

BCC Customer Service Center:

  • Call: 1-800-685-6100

M-TH: 8 am – 8 pm (ET), 5 am – 5 pm (PT)

F:  8 am – 6 pm (ET), 5 am – 3 pm (PT)

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SUBMITTING & RECEIVING CLAIMS REIMBURSEMENT:

For point-of-service payments (i.e. copays), present your FAHP Debit Card to the provider and they will swipe the card to cover costs immediately. For other payments, you will receive an Explanation of Benefit (EOB) statement from the carrier—keep these in case of verification.

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If you do not pay your bill with your FAHP Debit Card, complete the following steps:

  1. Make a copy of the EOB and attach it to your completed Reimbursement Form.

    • Reimbursement Forms are available on My SmartCare, from your HR Department, or at www.benxcel.com.

    • A separate claim form must be filled out for each patient.

  2. Submit your completed Request for Reimbursement Form and the claim substantiation to BCC:

  3. Once received, BCC will process and substantiate the claim for reimbursement, sending you payment via check or direct deposit.

Disclaimers:

* Each member is individually eligible for the plan if they meet the eligibility criteria (i.e. spouse and children can enroll without employee).

* New employees must satisfy eligibility requirements, which will be evaluated annually at FAHP open enrollment.

* Note: If the other employer-sponsored option has a different open enrollment period, try to request mid-year enrollment or you will have to wait until their open enrollment to waive your employers medical plan, enroll in your alternative coverage, and enroll in FAHP at that time.

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