Question 1

Are MVP Select PPO™ and Premier PPO™ available nationwide?

Accepted Answer

Yes. MVP Select PPO™ and Premier PPO™ are available in all 50 states. Check the provider network for your selected plan to confirm access to doctors and hospitals in your area.

Question 2

How many employees must enroll in an AffordaCare major medical plan?

Accepted Answer

At least five employees must enroll. If you offer both MVP Select PPO™ and Premier PPO™, each product must have at least five enrolled employees.

Question 3

Which employees are eligible for AffordaCare major medical coverage?

Accepted Answer

These plans are available to eligible full-time employees. The employer’s plan determines the specific eligibility requirements, including the required work schedule. Ask your HR team or agent to confirm eligibility before enrolling.

Question 4

Can employees enroll regardless of their health history?

Accepted Answer

Yes. The standard MVP Select PPO™ and Premier PPO™ offerings are guaranteed issue, so eligible employees can enroll without answering health questions. Coverage for a particular treatment or service still depends on the plan’s benefits and exclusions.

Question 5

What CHAMP participation is required with AffordaCare major medical coverage?

Accepted Answer

At least 25% of employees enrolled in the major medical coverage must also enroll in CHAMP. The CHAMP group must have at least five enrolled employees overall. Both requirements apply.

Question 6

What determines the premiums for AffordaCare major medical plans?

Accepted Answer

Premiums for the standard guaranteed-issue offerings are not based on an employee’s age, gender, or health history. The selected plan and benefit design determine the applicable rate. An alternative fully underwritten quote, when available, follows a separate review process.

Question 7

How do I check whether a doctor or hospital is in my major medical network?

Accepted Answer

Check the network listed for your selected plan or on your ID card, then use the matching provider directory: Cigna PPO: https://hcpdirectory.cigna.com/web/public/consumer/directory; PHCS PPO: https://providersearch.multiplan.com/; First Health PPO: https://www.firsthealthlbp.com/. Confirm participation for your specific plan before scheduling care.

Question 8

Can I cover my spouse and children under my major medical plan?

Accepted Answer

Yes. You can enroll your eligible spouse and children in the same MVP Select PPO™ or Premier PPO™ option you choose for yourself. Enrolled dependents receive that option’s covered benefits, subject to its deductible, copays, and family cost-sharing rules. Adding family members to CHAMP’s household virtual care does not enroll them in major medical coverage.

Question 9

When can employees enroll, and how long does open enrollment last?

Accepted Answer

Employees can enroll during their employer’s designated open enrollment period. The program does not set a minimum length for that window; enrollment periods typically last one to two weeks. Contact HR for your group’s dates and for instructions if you are a new hire or need to request a change outside open enrollment.

Question 10

What information do I need for a major medical quote?

Accepted Answer

No documents are required for an initial quote under the standard fixed-rate offering. For a meaningful comparison with your current coverage, provide your latest premium or renewal invoice and a summary of benefits. A fully underwritten quote has separate documentation requirements.

Question 11

When is the first premium payment due?

Accepted Answer

Your first premium payment is due on the first day of the month your coverage begins.

Question 12

Can I transfer deductible credit from my previous health plan?

Accepted Answer

Deductible credit may be available if your previous plan uses a calendar-year deductible that starts January 1. A transfer is not automatic. Ask your agent to confirm whether your prior deductible payments qualify.

Question 13

When do the major medical plans’ deductibles reset?

Accepted Answer

The deductibles for MVP Select PPO™ and Premier PPO™ reset each year on January 1.

Question 14

What is required to start AffordaCare major medical coverage?

Accepted Answer

The employer must submit a completed enrollment census listing the employees and dependents enrolling, their selected plan, and required personal information. The employer must also complete the intake form and sign the plan documents. These materials are used to set up the group and issue ID cards. Work with your agent to confirm the submission deadline and effective date, and use a secure upload link for sensitive information.

Question 15

Can an employer start or switch major medical coverage midyear?

Accepted Answer

An employer that does not currently offer health benefits can apply at any time of year. If you already offer coverage, the timing depends on your current contract. Level-funded plans commonly have a 12-month term, while some fully insured plans allow a midyear change. Have your agent review the contract and any termination obligations before switching.

Question 16

Are there fees in addition to the major medical premium?

Accepted Answer

No additional enrollment, setup, administration, or broker fees apply to these major medical plans. Copays, deductibles, and other costs for care still apply under the selected plan.

Question 17

Can an employer offer a health flexible spending account (FSA) alongside these plans?

Accepted Answer

Generally, yes. An employer can offer a health flexible spending account (FSA) alongside other employer-sponsored benefits through a Section 125 cafeteria plan. Your benefits administrator can help coordinate the FSA with your medical plan and any health savings account (HSA) option.

Question 18

What dental and vision options are available?

Accepted Answer

Dental and vision options can be tailored to your group’s location and employee demographics. Ask your agent for available plans and pricing. An employee census is typically needed to prepare a quote.

Question 19

Can employees pay premiums through payroll deductions?

Accepted Answer

Yes. Employee premiums can be deducted from each paycheck. Pre-tax deductions are available when the employer has the appropriate Section 125 cafeteria plan in place.

Question 20

Where should I submit documents for a quote?

Accepted Answer

Ask your agent for a secure upload link if documents are needed. Do not send Social Security numbers, banking details, or other sensitive information through ordinary email.

Question 21

Is fully underwritten pricing available for these plans?

Accepted Answer

An alternative, fully underwritten quote may be available for groups with more than 100 participants and a favorable health and claims profile. Required materials include a completed enrollment census, a current invoice, and Tier 1 and Tier 2 claims data for the previous 12 months. Ask your agent whether your group qualifies.

Question 22

Why do some AffordaCare major medical options cost less than others?

Accepted Answer

Plan prices vary with the benefits and cost sharing you choose. Deductibles, copays, coinsurance, and the out-of-pocket maximum all affect the premium. Compare both the monthly premium and the amount employees may pay when they receive care.

Question 23

Who manages plan renewals?

Accepted Answer

Your agent of record coordinates the renewal process, including enrollment updates and required plan documents. The agent works with the employer and plan administrator to help the group transition into the next coverage period.

Question 24

Does MVP Select PPO™ meet the ACA’s minimum value standard?

Accepted Answer

Yes. MVP Select PPO™ meets the Affordable Care Act’s minimum value standard. This standard generally means a plan covers at least 60% of expected allowed benefit costs and provides substantial coverage for inpatient hospital and physician services. It does not mean the plan pays 60% of every individual medical bill.

Question 25

Do AffordaCare major medical plans cover care or employees outside the United States?

Accepted Answer

No. MVP Select PPO™ and Premier PPO™ do not cover medical care received outside the United States and are not available to employees who live outside the United States.

Question 26

Is MVP Select PPO™ fully insured, self-funded, or level-funded?

Accepted Answer

MVP Select PPO™ is a level-funded plan.

Question 27

Is there an MVP Select PPO™ option that allows contributions to a health savings account (HSA)?

Accepted Answer

No. MVP Select PPO™ does not meet the requirements for a health plan that allows health savings account (HSA) contributions.

Question 28

Who administers MVP Select PPO™ and Premier PPO™?

Accepted Answer

Marpai administers MVP Select PPO™ and Premier PPO™. For help with your coverage, use the contact information on your member ID card. You can learn more about Marpai at https://www.marpaihealth.com/.

Question 29

Which provider network does MVP Select PPO™ use?

Accepted Answer

MVP Select PPO™ uses the PHCS provider network. Search for participating providers at https://providersearch.multiplan.com/ and confirm participation for your specific plan before receiving care.

Question 30

When is phone support available for the major medical plans?

Accepted Answer

Live phone support for MVP Select PPO™ and Premier PPO™ is available from 8 a.m. to 8 p.m. Eastern Time. Call the number on your member ID card. Calls are recorded.

Question 31

How does prior authorization work for MVP Select PPO™?

Accepted Answer

Some services require approval before you receive care. Ask your provider to contact the plan administrator using the information on your ID card and obtain any required prior authorization before treatment. Missing a required approval can result in a denial of coverage. If you are unsure whether approval is needed, call member services.

Question 32

What would I pay out of pocket with Premier PPO™?

Accepted Answer

Your costs depend on the Premier PPO™ option you select. You may pay a deductible, fixed copays for some services, and coinsurance, which is a percentage of covered costs. Review your option’s Summary of Benefits and Coverage (SBC) for the amounts. Premiums and noncovered expenses do not count toward the out-of-pocket maximum.

Question 33

Is there a Premier PPO™ option that allows contributions to a health savings account (HSA)?

Accepted Answer

Yes. Premier PPO™ offers options designed to work with a health savings account (HSA). To contribute, you must select a qualifying high-deductible health plan and meet the other HSA eligibility rules. If you also enroll in CHAMP, choose its HSA-compatible version. Ask your agent to coordinate the two plans before making HSA contributions.

Question 34

Which network does Premier PPO™ use, and is Cigna the insurer?

Accepted Answer

Premier PPO™ uses the Cigna PPO network where available. Some groups may use the PHCS or First Health network instead. The network name identifies participating providers; it does not identify the insurer or plan administrator. Check your plan documents or ID card for your group’s network.

Question 35

Does Premier PPO™ include out-of-network benefits?

Accepted Answer

Yes. Premier PPO™ includes out-of-network benefits. Review your plan’s Summary of Benefits and Coverage (SBC) for the specific benefits and cost-sharing requirements before receiving care.

Question 36

Does CHAMP provide minimum essential coverage, and how does it differ from minimum value?

Accepted Answer

CHAMP includes a minimum essential coverage (MEC) component. MEC identifies a category of health coverage recognized under the Affordable Care Act; it does not describe a full set of major medical benefits. Minimum value is a separate standard that generally requires a plan to cover at least 60% of expected allowed benefit costs and provide substantial inpatient hospital and physician coverage. CHAMP does not provide minimum value, so it should not be treated as a replacement for a major medical plan that meets that standard.

Question 37

Can an employer start CHAMP at any time of year?

Accepted Answer

Yes. An employer can begin CHAMP at any time of year. A CHAMP representative can help coordinate the launch, payroll setup, and employee enrollment.

Question 38

Can an employer add CHAMP while keeping its current major medical plan?

Accepted Answer

Yes. CHAMP can supplement an employer’s existing major medical plan. It is designed to provide additional everyday healthcare benefits while the employer keeps its current medical coverage.

Question 39

Can an employer that already offers CHAMP add AffordaCare major medical coverage?

Accepted Answer

Yes. An employer that already offers CHAMP can add MVP Select PPO™ or Premier PPO™ if the group meets the major medical eligibility and participation requirements. CHAMP participation is required as part of the AffordaCare major medical offering.

Employer Health Benefits FAQ

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Employer Health Benefits FAQ

Explore your questions.

Have questions aboutyour benefits strategy?

Have questions about
your benefits strategy?