Texas Chamber Health Program
Exclusive Health Program for Chamber Members
Potential Premium Savings: 15-25%
Affordable major medical and ancillary benefits designed for small and medium-sized businesses, sole proprietors, and 1099 contractors to join together and have access to competitive group health benefits. We are always looking to improve our member benefits and saw the need for quality healthcare at an affordable rate.
Simplified Underwriting
Preset Rate Tiers – Each member group is underwritten, and if approved, placed into one of our preset custom rate tiers, which are established and disclosed from the outset.
Groups Under 12 – Groups with fewer than 12 enrolled employees complete underwriting through a secure, custom online application portal.
Groups Over 12 – Groups with more than 12 enrolled employees are underwritten using a dependent-level census and AI-supported risk assessment tools.
Plan Options
FAQs
Member companies in good standing (per bylaws) may join the Health Program. The benefits are offered to you, your employees and their dependents.
This healthcare program was built in partnership with Triad Benefits as an exclusive member benefit for Grapevine Chamber members. Companies or individuals are able to offer their employees as well as any dependents quality healthcare coverage with affordable monthly costs and long-term rate stability.
All enrolling members will go through underwriting to determine their rates. Groups under 12 enrolling employees will need to complete a personal health questionnaire (PHQ) to determine the custom rate tier they qualify for. PHQs are collected through a secure online portal and delivered to underwriting. Any group that has current group coverage in place must also provide a copy of current benefits and rates. If a renewal is available, that will be required as well. Once rates are tabulated and delivered based on the above information, group can decide to move forward with their custom benefits package.
All enrolling members will go through underwriting to determine their rates. Groups over 12 enrolling employees can simply submit a dependent level census in order to do underwriting. Any group that has current group coverage in place must also provide a copy of current benefits and rates. If a renewal is available, that will be required as well. Once rates are tabulated and delivered based on the above information, group can decide to move forward with their custom benefits package.
This program uses custom rate tiers to price members. The tier determination is based on age, gender, and health history. Healthier groups qualify for lower rate tiers and older groups with more risks qualify for higher rate tiers.
Plans and rates are good for one year from the initial offering date. Once signed up, the member cannot cancel coverage during the plan year (12 months). Groups will receive advanced notice of changes or termination upon renewal, as state and federal laws require. When a member group sets up a plan, it is considered as the plan sponsor for that plan for the purposes of ERISA compliance.
Each member group can choose their own plan designs as well as the best network that will work for them. Cigna PPO Network. Cigna Provider Link
Reference based pricing with PHCS Practitioner and Ancillary Network for providers PHCS PAN Provider Link
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 apply. It is always suggested to visit an urgent care or utilize the Telemedicine services for any non-emergency situations.
Member companies are eligible to enroll at any point throughout the year. Effective dates will always be on the first of the month. For in-force member groups, an employee needs to satisfy the company’s waiting period or have a qualified life event (QLE) to enroll.
There is no minimum for enrollment. Groups as small as one employee can enroll. There are also no participation requirements, which allows for groups in special situations to enroll.
The Triad Benefits Health Program is governed by the Employee Retirement Income Security Act (ERISA). This means that they are federally governed and do not necessarily have to adhere to each state’s rules/guidelines.
This is not an available option at this time. The Chamber has an agreement to offer coverage to its membership exclusively through Affinity Benefits.
The Reference Based Pricing (RBP) program is an ‘open network’ program. There are no network restrictions when utilizing a hospital or facility-based service. This typically handles the high cost, low frequency services. This plan does incorporate a network through PHCS PAN for any professional or doctor related services. This will handle any of the low cost, high frequency services that members may receive.
Employees and their dependents are covered at any facility of their choice, in or out of network. However, on the Cigna network plan, out of network benefits (at a higher member cost share) may apply.
The benefits covered under the health program are described in the Summary of Benefits and Coverage that is available upon request. Full detailed information for the employer can be found in the Summary Plan Description, available upon request. The Triad program doesn’t cover dental or vision benefits. However these benefits are available through your partnership with Affinity Benefits.
The program is available to any member companies and their employees. The program is able to work with 1099 contractors but that requires additional setup. Individuals are NOT able to be written under this program when there is no affiliation with a company.