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Posted: 09-08-04 If a member changes medical Plans on July 1st, what happens to the Deductible and Co-insurance applied under the previous Plan? Any Deductible or Co-insurance applied between January 1st and June 30th is credited to the new Plan. Posted: 05-24-04 Isn’t
Tri-County Schools Insurance Group an insurance company? No.
Insurance companies are for-profit businesses who sell insurance
coverage, and whose profits go to the owners or stockholders.
Tri-County Schools Insurance Group is a non-profit, joint powers
authority, owned by its member employers. Every
employer of the pool is an owner. What
is a pool? A
group such as Tri-County Schools Insurance Group pools the resources, premiums,
of each member employer in order to pay for the medical, dental, vision and life
insurance claims of its covered employees.
We also have employers paying into a pool to protect against lawsuits and
property losses. Tri-County
Schools Insurance Group does not set the premium rates with a profit motive.
The pool was formed twenty plus years ago so that it could step outside
of the insurance market which was charging whatever the traffic would bear.
Tri-County Schools Insurance Group pools its resources to create a fund
that will be sufficient to cover the claims losses and expenses, and if there
are fewer losses, more of the resources remain available to offset any rate
increases. “A
pool is actually the earliest form of an insurance company.
Some ship owners in the 16th century decided to band together
and post a certain amount of money as a bond every time a vessel sailed.
Because each owner had so much invested in the cargo of each ship, if
they lost a single ship they could go broke.
But they figured out that on any given sailing, only one of them was
likely to suffer a disaster. So
they each contributed a little bit to a “disaster fund” which was sufficient
to pay off the unlucky one who lost a ship on occasion. If there were no disasters, the fund stayed inviolate until
needed. So they only had to pay out
when there was a loss. These
early groups were self-insuring. They
pooled their resources to create the disaster fund.
Later on middle men with a lot of cash got into the business of insuring. But in order to make it worth their while to assume the risk
for someone else’s disaster, they built profit into the rates they set.
This is what an insurance company does.”
(AGRIP,
Volume6, Number 2) How
are rates set? Tri-County
Schools Insurance Group uses the same actuarial methods as insurance companies
to predict losses and set rates, in order to ensure that the pool collects
enough premiums to remain viable and solvent.
Except, Tri-County Schools Insurance Group’s goal is to break even,
not to make a profit. Previously asked questions: What is Deductible? The accumulated amount of Covered Expenses incurred throughout the Calendar Year which the Covered Person must pay before any Benefit Percentage (Co-insurance) applies. What
is
Co-insurance? The percentage payable by either the Plan and the Covered Person for covered benefits that are provided under the Plan. The Co-insurance is applied to Covered Expenses after the Deductible has been met. For example, Plan Premier Plus, after the $75 Deductible has been met, the Plan pays 80% of the Covered Expenses and the individual is responsible for 20%. What are Copays? A cost sharing arrangement whereby a Covered Person pays a set amount for a specific service or supply at the time that service or supply is provided. For example, a $10 office visit Copay. Copays do not apply toward a Covered Person's Deductible or Co-insurance. When do the Deductible and Co-insurance begin? The Deductible and Co-insurance are based on a Calendar Year from January 1 through December 31. What
process is used to change an existing plan? Plan changes are considered by the Executive Committee. A subcommittee, Benefits Review Committee, is established from members of the Executive Committee. Plan changes are also reviewed by the Employee Benefits Advisory Committee. They review the requested change(s), to determine if it will be of benefit to the membership including the financial impact on the Plan. Each plan change consideration is analyzed by TCSIG's actuary. Some Plan changes are necessitated by law and others such as our recent changes are being made in an effort to make the Plans more uniform and easily understand by our participants. Who
approves changes? Once the plan changes have been finalized they are approved by the Executive Committee. What
is the make up of the committee and how are its members appointed? The JPA Board of Directors consists of one representative from each of our participating member districts or county offices of education. Members of the Board of Directors are designated by the superintendent of each participating district or county office of education. The Executive Committee is made up from designated representatives to the JPA Board of Directors who have been elected by the Board to a two-year term. How
many participants are necessary to maintain a plan? TCSIG has established a policy based on analysis by it's actuary that a viable plan must have at least 100 participants enrolled in the Plan in order for the Plan to be offered by TCSIG. If
a majority of them (employees) approve, can a plan be changed? No. Plan changes must be considered and approved by the Executive Committee with input from the Employee Benefits Advisory Committee. |
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Copyright © 2001 Tri-County Schools Insurance Group Phone: (530) 822-5299 or Toll-Free (866) 822-5299 Last modified: 04-22-08 Questions? Webmaster This website created by: TCSIG Staff
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