Orthotics & Prosthetics Insurance

Member companies in good standing (per AOPA bylaws) may join the AOPA Affinity Health Plan. The benefits are offered to you, your employees, and their dependents.

AOPA is always seeking to improve our member benefits. We saw an opportunity to offer our membership a quality healthcare solution with long term rate stability, built EXCLUSIVELY for AOPA members.

This health insurance program was built EXCLUSIVELY for AOPA members and offers you, your employees, and their dependents quality healthcare with affordable monthly premiums and long term rate stability.

All enrolling members will submit a Personal Health Questionnaire (PHQ). The PHQs are collected through a secure portal and dropped into a HIPAA compliant database. The PHQ is a summary of your health history. Utilizing the combined history of an organization’s popuation, customized rates can be formulated.

The cost is to be determined after the census gathering portion of the process. There is no way to determine exact rates until the stop-loss carrier can see a sample of the groups, but we have traditionally seen rates anywhere from 10% - 25% lower than the marketplace for comparable products. We also implement a tiered rating system for the plan that helps reach a majority of the groups.

Plans and rates are good for one year from the initial offering date of 2022. Once launched, the AOPA Affi¬nity Health Plan cannot cancel the coverage during the plan year. Groups will receive advance notice of changes or termination upon renewal, as state and federal laws require.

The AOPA A¬ffinity Health Plan offers the following options:

If you are experiencing a true medical emergency then you can go to any hospital’s emergency room. If it is not a true emergency, some restrictions may apply.

The Reference Based Pricing option is an “open network” program. While members can see a provider in the PHCS network, they can also see any provider and they will be covered.

Employees are covered at their own facility or that of their spouse or parent.

When switching to a new health plan, you must go through the authorization procedures of the new plan. Through a partnership with My Advocate Pro, the AOPA A¬ffinity Health Plan has a team of highly trained consumer advocates ready to assist with the process.

The health plan covers all essential coverages required by the ACA as any carrier product. The health plan does not provide dental but it can be purchased as a separate benefit from your agent.

The open enrollment period will be 30 days prior to launch (1/1/22) and 30 days post-launch (1/30/22).

The plan is offered at the AOPA member company level, not the individual level.

The plan requires two eligible employees to enroll. Those employees can be related.

On the $7350 deductible plan there is an integrated Rx/pharmacy card. This allows members access to discounted pharmaceutical pricing that will seamlessly accumulate towards a member’s annual deductible. Discount cards are integrated with the PBM so AOPA members do not have to worry about keeping track of a separate bene¬fit card. Show your ID card at the pharmacy counter and let the AOPA Affinity Health Plan do the rest. This is exclusive to the $7350 Plan as drug copays are generally cheaper on the lower deductible plans. In many cases, the discount pharmacy card has less expensive tier 1 & 2 generics for members.

Yes, these plans are subject to ERISA.

That is not an available option at this time.

Yes, Orthotics & Prosthetics are covered at 80% after deductible for all plans.