SGH SecureHealth Plans
SGH SecureHealth Plans offer a range of flexible and affordable health insurance options designed to meet diverse healthcare needs and budgets. These plans are structured to provide comprehensive benefits, including preventive care, prescription drug coverage, and telemedicine services, ensuring members can access essential healthcare services without incurring significant out-of-pocket expenses. The plans are available in various tiers—SecureHealth Value, SecureHealth Preferred, and SecureHealth Elite—each tailored to offer different levels of coverage and benefits to suit individual preferences and financial situations.
By leveraging the extensive PHCS PPO Network, SGH SecureHealth Plans ensure members can access various healthcare providers and facilities nationwide. This network includes over 700,000 physicians and 6,000 hospitals, providing ample choice and convenience for members seeking medical care. Additionally, the plans adhere to the Affordable Care Act (ACA) guidelines for preventive services, guaranteeing that essential health services such as annual check-ups, immunizations, and cancer screenings are covered at no additional cost to the member.
SGH SecureHealth Plans are designed to provide immediate healthcare benefits and help manage long-term healthcare costs through data-driven cost management strategies. These strategies include negotiating favorable rates with healthcare providers and utilizing data science to identify areas where costs can be reduced without compromising the quality of care. This approach ensures that members receive high-quality healthcare services while maintaining affordability.
Overall, SGH SecureHealth Plans represent a comprehensive, cost-effective solution for individuals and families seeking reliable health insurance coverage. With a focus on preventive care, flexible plan options, and extensive provider networks, these plans are well-suited to meet their members’ evolving healthcare needs.
START FREE ONLINE QUOTE NOW
At Blake Insurance Group, we respect your privacy. Your personal information is used solely for quote purposes and is not shared or sold
Plan Overview
PHCS Specific Services PPO Network
The SGH SecureHealth Value plan provides access to the PHCS Specific Services PPO Network, the largest independent, nationwide primary preferred provider organization (PPO) in the United States. This network includes over one million healthcare providers, 920,000 practitioners, 4,800 acute care hospitals, and 87,000 ancillary facilities. The PHCS Network is known for its flexibility, allowing health plans to customize their provider networks to meet specific needs without sacrificing access, savings, or quality. Members must use in-network providers as the plan does not cover out-of-network services.
Preventive Benefits Under PPACA
The SGH SecureHealth Value plan includes preventive benefits that comply with the Patient Protection and Affordable Care Act (PPACA). These benefits cover a range of preventive services at no additional cost to the member, provided they are obtained from in-network providers. Preventive services include annual check-ups, immunizations, cancer screenings, and other essential health services recommended by expert medical bodies such as the U.S. Preventive Services Task Force (USPSTF) and the Advisory Committee on Immunization Practices (ACIP). This ensures that members can access necessary preventive care to maintain their health and prevent more serious health issues from developing.
Limitations and Exclusions
The SGH SecureHealth Value plan has specific limitations and exclusions that members must be aware of. These include:
– **Service Locations**: The plan does not cover hospital services. All covered services must be provided at in-network doctor offices or freestanding facilities.
– **Service Types**: Certain types of services and treatments may not be covered under the plan. Members are encouraged to review their plan documents thoroughly to understand what is and isn’t covered.
– **Pre-existing Conditions**: While the plan is a guaranteed issue, meaning no one is turned down based on health status, there may still be limitations on coverage for pre-existing conditions depending on the plan’s specific terms.
– **Out-of-Network Services**: As mentioned, the plan does not cover services provided by out-of-network providers. Members must ensure they use in-network providers to receive coverage.
Coverage of Services
The SGH SecureHealth Value plan covers services obtained at in-network doctor offices and freestanding facilities. This includes:
– **Primary Care Visits**: Members can visit primary care physicians within the PHCS Network for routine check-ups and non-emergency medical care.
– **Preventive Services**: As part of the PPACA compliance, the plan covers preventive services such as screenings, immunizations, and wellness visits at no additional cost to the member.
– **Prescription Drug Coverage**: The plan includes a prescription drug benefit, which may vary depending on the specific tier of the plan chosen (Value, Preferred, or Elite).
Enrollment and Billing
Enrollment Confirmation Process
The SGH SecureHealth Value plan has implemented a streamlined enrollment confirmation process to ensure members have immediate access to their plan information:
Welcome Email: New members receive a comprehensive welcome email within 24 hours of successful enrollment. This email is the initial point of contact and contains crucial information about the plan.
– **Temporary ID Cards**: The welcome email includes temporary ID cards, allowing members to access healthcare services immediately without waiting for physical cards to arrive.
– **Plan Information**: The welcome email provides detailed plan information, giving members a clear understanding of their coverage, benefits, and how to utilize their new health plan effectively.
Billing Procedures
The plan utilizes an automatic payment system to simplify the billing process for members:
– **Automatic Drafts**: Monthly payments are automatically drafted from the member’s designated credit card or banking account. This ensures timely payments and continuous coverage.
– **Payment Flexibility**: While automatic drafts are the default, members can cancel this arrangement if they prefer an alternative payment method.
– **Customer Service Support**: Members can contact customer service to make changes to their payment arrangements or address any billing-related queries.
Cancellation Policy
The SGH SecureHealth Value plan offers a generous cancellation policy, providing members with flexibility and peace of mind:
– **30-Day Window**: Members have a 30-day period from their effective date to cancel their plan if unsatisfied.
– **Potential Full Refund**: Cancellations within this 30-day window may be eligible for a full refund, subject to the plan’s terms and conditions.
– **Cancellation Process**: Members must contact customer service directly to initiate a cancellation. This ensures that cancellations are processed correctly and any refunds are handled promptly.
– **Customer Service Hours**: Cancellations are processed during customer service operating hours, Monday through Friday, from 7 a.m. to 7 p.m. Central Time.
This enrollment and billing structure is designed to provide members with a smooth onboarding experience, convenient payment options, and the flexibility to make changes if needed. The 30-day cancellation policy demonstrates the plan’s commitment to member satisfaction and confidence in the value of their health coverage offering.
Member Responsibilities
The SGH SecureHealth Value plan significantly emphasizes member engagement and informed decision-making. To ensure that members fully understand and maximize their benefits, the plan outlines specific responsibilities for its members:
Review of Plan Materials
Members are strongly encouraged to review all plan-related materials thoroughly:
– **Comprehensive Reading**: Members should carefully read through all documents provided, including the plan summary, benefit details, and any additional informational materials.
Understanding Coverage: It’s crucial for members to clearly understand what is covered under their plan, including any limitations or exclusions.
– **Proactive Engagement**: Members are advised to actively understand their health coverage by thoroughly examining all provided materials.
– **Clarification of Doubts**: If any planning aspect is unclear, members are encouraged to seek clarification promptly.
Customer Service Interaction
The plan emphasizes the importance of utilizing customer service resources:
– **Addressing Questions**: Members should not hesitate to contact customer service with any questions or concerns about their coverage.
– **Timely Inquiries**: It’s recommended that members address any uncertainties as soon as they arise to avoid potential misunderstandings or issues with coverage later.
Utilization of Resources: Members are encouraged to fully utilize available customer service channels, including phone support, email, and any online resources provided.
Consent to Electronic Transactions
In line with modern healthcare practices, the plan incorporates electronic processes:
Electronic Consent: By enrolling in the plan, members consent to engage in electronic transactions related to their health coverage.
– **Digital Signatures**: Members agree to the use of electronic signatures for plan-related documents, streamlining administrative processes.
– **Document Management**: Plan documents and communications may be provided electronically, requiring members to manage and store these digital records.
Voice Consent as Legal Signature
The plan recognizes voice consent as a legally binding form of agreement:
– **Recorded Verification Calls**: During the enrollment process or for certain plan changes, members may participate in recorded verification calls.
– **Legal Equivalence**: For legal purposes, voice consent provided during these recorded calls is considered equivalent to a written signature.
– **Binding Agreement**: Members should understand that their verbal agreement during these calls constitutes a legally binding commitment to the terms discussed.
The SGH SecureHealth Value plan aims to create an informed and engaged membership base by outlining these responsibilities. This approach helps members make the most of their health coverage, ensures smooth plan administration, and reduces the likelihood of misunderstandings or disputes. The emphasis on electronic transactions and voice consent reflects the plan’s commitment to efficient, modern healthcare management practices.
Plan Options and Costs
The SGH SecureHealth plan offers four tiers of coverage with different benefits and costs:
Value Plan:
– Cost: $99 per month for a primary member
– Features: Basic coverage with lower premiums
Value+ Plan:
– Cost: $125 per month for a primary member
– Features: Slightly enhanced coverage compared to Value plan
Preferred Plan:
– Cost: $157 per month for a primary member
– Features: More comprehensive coverage than Value and Value+ plans
Elite Plan:
– Cost: $187 per month for a primary member
– Features: Most comprehensive coverage option
Family Plan Options:
The costs for family plans vary depending on the number of covered individuals. The plan offers options for:
– Primary member & spouse
– Primary members & children
– Full family coverage
While specific costs for these family options are not provided, they would likely be higher than the individual member rates listed above. The exact pricing would depend on the chosen tier (Value, Value+, Preferred, or Elite) and the number of family members covered.
These tiered options allow individuals and families to choose a plan that best fits their healthcare needs and budget. The Value plan offers the most affordable monthly premium, while the Elite plan provides the most comprehensive coverage at a higher cost.
SGH SecureHealth Plans Comparison
| Plan Tier | Monthly Cost (Primary Member) | Key Features |
|---|---|---|
| Value | $99 | - Basic coverage - Lowest premium |
| Value+ | $125 | - Slightly enhanced coverage compared to Value plan |
| Preferred | $157 | - More comprehensive coverage than Value and Value+ plans |
| Elite | $187 | - Most comprehensive coverage option |
Notes:
- All plans include access to the PHCS Specific Services PPO Network
- Coverage does not include hospital services
- Services must be provided at in-network doctor offices or freestanding facilities
- Preventive benefits under the PPACA are included
- Family plan costs vary based on the number of covered individuals
- Plans have specific limitations and exclusions
Additional Information
Prescription Benefits
The SGH SecureHealth plans offer a tiered prescription drug benefit structure:
Generic Medications: These typically have the lowest copays, making them the most affordable option for members.
Brand-Name Medications: These usually have higher copays than generic drugs but are still covered by the plan.
Specialty Medications: While not explicitly mentioned, many plans include a separate tier for specialty drugs, often with the highest copays or coinsurance rates.
The specific copay amounts are not provided, but the tiered structure suggests that the plan is designed to encourage the use of generic medications to help control costs for both members and the plan.
Preventive Services
The SGH SecureHealth plans place a strong emphasis on preventive care:
Comprehensive Coverage: The plans include coverage for various preventive services, aligning with the Affordable Care Act (ACA) requirements.
No Cost-Sharing: Preventive services are typically covered at 100%, meaning members do not have to pay copays, coinsurance, or deductibles for these services when obtained from in-network providers.
Specific Procedures: The plan explicitly mentions coverage for important preventive screenings such as:
– Colonoscopies: Crucial for early detection of colorectal cancer.
– Mammograms: Essential for breast cancer screening.
Flexible Facility Options: Members can obtain these preventive services at any in-network facility, providing flexibility and convenience in accessing care.
ACA Compliance: By offering these services, the plan ensures compliance with the ACA’s preventive care mandates, which require non-grandfathered health plans to cover preventive services without cost-sharing.
Legal and Compliance
The SGH SecureHealth plans have implemented robust legal and compliance measures to ensure transparency, understanding, and consent from their members. These measures protect the members and the insurance provider while adhering to regulatory requirements.
Sales Process and Disclosures
**Telephonic Sales:**
– The primary method of conducting sales is through telephone conversations.
– This approach allows for direct communication and immediate clarification of questions or concerns.
**Recorded Verification:**
– Sales calls are recorded to document the interaction and verify the member’s understanding and consent.
– These recordings serve as a legal transaction record and can be referred to if any disputes arise later.
**E-Sign Authorization:**
– As an alternative to recorded verification, members may provide electronic signatures to confirm their enrollment and understanding of the plan.
– This method complies with the Electronic Signatures in Global and National Commerce (E-SIGN) Act, ensuring the legal validity of the electronic agreement.
**Comprehensive Explanation:**
– During the sales process, representatives are required to provide a thorough explanation of:
– The product features and benefits
– Associated costs, including premiums, copays, and any other out-of-pocket expenses
– Any limitations or exclusions of the plan
Member Acknowledgment
**Terms and Conditions:**
– Members must explicitly acknowledge that they understand and agree to the plan’s terms and conditions.
– This acknowledgment covers all aspects of the plan, including coverage details, member responsibilities, and legal obligations.
**Automatic Payment Plan:**
– Members must specifically acknowledge their agreement to the automatic payment plan.
– This includes understanding how payments will be processed, on what dates, and from which accounts.
**Plan Limitations:**
– Members must confirm their understanding of any limitations or exclusions in the plan.
– This may include network restrictions, coverage limits, or specific services that are not covered.
**Documentation:**
– The member’s acknowledgment is documented through the recorded verification or e-signature process.
– This documentation proves the member’s informed consent and agreement to the plan’s terms.
Regulatory Compliance
**State and Federal Regulations:**
– The sales and enrollment process is designed to comply with all applicable state and federal health insurance sales regulations.
**Transparency Requirements:**
– The disclosure process adheres to transparency requirements set forth by regulatory bodies, ensuring that all material information is provided to potential members.
**Consumer Protection:**
– These measures align with consumer protection laws, safeguarding members’ rights to make informed decisions about their health insurance coverage.
SGH SecureHealth plans aim to create a transparent, ethical, and legally sound enrollment process by implementing these legal and compliance measures. This approach protects the company from potential legal issues and ensures that members fully understand the product they are purchasing, leading to better satisfaction and fewer misunderstandings or disputes in the future.
FAQs related to SGH SecureHealth Plans
- Value: $99/month
- Value+: $125/month
- Preferred: $157/month
- Elite: $187/month