Uncover the values-based partnership
bringing associations & employer groups
that much-anticipated opportunity
empowering them to grow in every aspect of
their healthcare initiatives.
A Service That Actually Empowers You!
All customer service and claims management is managed by Paragon Benefits Inc. in Columbus, Georgia. They are a subsidiary of the Georgia Bankers Association Insurance Trust; arguably one of the finest success stories and well managed Trusts in the country. They’ve been delivering health insurance services for over 35 years and have built a customer centric service model with some of the highest quality ratings in their industry.
Simplicity and administration efficiencies are two of the primary benefits of 4FRONTTM. All of the services and vendors are integrated into simple customer interfaces so that most of the complicated steps and processes are eliminated. Your employees will have a mobile application to download that gives them access 24 hours a day, 7 days a week, to information and service and health providers. We’ve designed the program to be a virtual-health model so that employees can access providers anywhere and almost anytime, day or night. We even have wellness incentives and concierge type services that will guide employees through the healthcare maze.
Who is Eligible for 4FRONT™?
4FRONT™ is designed for smaller employers and there are some size limitations and underwriting requirements in order to be accepted. The primary group size is a minimum of 5 eligible employees however, some states have placed additional limitations designed to protect their State’s Exchange or small group pool. All eligible employees are required to complete an individual health questionnaire. Employers are required to provide detail on their current plans and several years of premium history. Larger employers will need to submit claims history.
Your broker can assist you through the process and once all of the information is obtained, the reinsurer will complete an underwriting assessment and rates will be furnished to you for consideration.
To learn more about how our custom solution will retain members, increase revenue, and make life simpler simply call or email us.
Mark Lamberth
(859) 533-8301
mlamberth@capstonebenefits.com
Richard Brewer
(404) 409-5741
rbrewer@paragonbenefits.com
Stephen James
(317) 750-8109
sjames@capstonebenefits.com
One Way The Plan Would Work
Your monthly group health premium paid to 4FRONT™ for your group is comprised of three components:
- Administrative Costs – paid to the contracted program service vendors
- Custom Stop Loss Coverage – paid to the reinsurance carrier and to the Captive Insurer
- Claims Fund – reserved to pay monthly claims
The reinsurance carrier and 4FRONT™ predetermine your maximum annual claims estimate, including claims terminal liability and you pay 1/12 of that cost each month during the Plan year. There are not additional claims charges during the Plan year.
At the end of the Plan year, any unused claims reserve dollars can be used to reduce future premium rate adjustments for your group.
It’s Good To Know!
4FRONT™ is primarily governed by federal ERISA laws with additional guidance in certain states. ERISA plans, similar to what guides large employer plans, differ from state mandated benefit plans, which can result in lower costs and expenses for sponsoring employers.
For employees, the ERISA plan, as described in their Summary Plan Description (SPD), will be similar to the benefits they may be familiar with in a fully insured plan with co-pay, deductible and out-of-pocket expenses.
Each employee will have access to their SPD detailing their benefits as they enroll in the 4FRONT™ health plan. All of the plans are considered major medical coverage and are ACA compliant with benefit level maximums.
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