Group Plan Solutions has the expertise and experience to effectively and efficiently guide the administration of your employees’ benefit claims for their health plans. With a commitment to settling health care plan claims quickly and easily, you can be assured that your employees’ health care benefit claims will be taken care of professionally and with the highest level of service possible.
Your employees deserve the best administration of their health care plan benefit claims, and we firmly believe that employee benefit claim costs can be managed competently by implementing our proven innovative technological resources and top-rated service that perform Beyond the expected.® Group benefits are among the most desirable of employee benefits, and you and your employees can trust our knowledge and experience in the administration of health plan benefit claims.
Our website provides you with the necessary tools to confidently assure your employees that their employee benefit health care plan claims are being settled with top-rated performance. As a self-insurer, you assume the major cost of your employee’s health benefit plans, while we commit to keeping peace of mind for your employees first and foremost in all of our employee health plan claim procedures.
If you would like to learn more about Group Plan Solutions or are ready to submit a request for a proposal, please contact us at 888-301-0747 or by email.
We will be happy to assist you and discuss the information we will need to get you the most accurate quote.
The key components we will need first include:
- Full contact information for the person who will be filing the Request for Quote.
- Full contact information for the company the quote is being requested for.
- Proposed plan effective date.
- The number of eligible employees.
Once you contact us, we can promptly provide you with a full questionnaire and what we will need for the quoting process. We will also discuss the pertinent reports and documentation that will need to be included with the completed questionnaire.
If you need assistance, please contact us at 888-301-0747 or email us.
When your employees have medical claims, keeping track of all of their bills and claim payments can be overwhelming. To help them track claims, we provide 24-hour online access to claim information. They can review all of the claims that have been filed under their Group Plan Solutions Medical and Dental Plans, or Flexible Spending Plans for medical or dependent care.
Feel free to contact the Claim Department with any questions you may have at 888-301-0747 or email.
For most of our health plans that offer a prescription drug card, the prescription benefits are managed by Magellan RX. Group Plan Solutions and Magellan RX are committed to providing our insureds with access to the safest, highest-quality and most effective prescription plans. We want to help you and your family to be informed and involved health care consumers. there are many online resources now available to your from Magellan RX.
If you are having trouble logging in, feel free to contact Group Plan Solutions at (800) 371-9622, Extension 3281 for assistance.
- Welcome Booklet
- Mail Order Form
- Preferred Drug Summary (Formulary)
- Preferred Drug Full List (Formulary)
If your health plan has chosen another prescription benefit manager besides Magellan RX, such as OptumRx, TrueRx, or ProAct, please contact Group Plan Solutions at 1-800-371-9622 extension 3281 for more details.
To request a new ID card, click on the link below.
Making sure your employees are choosing the correct In-Network Provider will help them get the highest level of benefits under your plan.
Click on the Find a Provider button below to view the different networks GPS offers. Not all networks are available in all areas. Be certain to reference your summary plan document to determine your correct network. Only the network you chose can be accessed at the In-Network rate. If you are unsure of your network, please call us to confirm your network at 888-301-0747. Failure to use the correct network will greatly reduce your employees’ benefits.
Focus your valuable time and attention on your business, and let us provide you with the protection and peace of mind that come with administering COBRA for your employees.
Follow the link to learn the benefits of Group Plan Solutions.
How to Quit Smoking
Youth Tobacco Prevention
Alcohol Abuse and Alcoholism Information
Parents Prevent Childhood Alcohol Use
Guide to Healthy Living
Grandfathered Health Plans
Under the Patient Protection and Affordable Care Act (PPACA), provision was made to allow people already covered by health insurance to keep that coverage. The term “grandfathered plan” was created to describe those plans that were in existence on March 23, 2010. Grandfathered plans are exempt from much of the new insurance reforms of the PPACA, as long as they retain their grandfathered status.
What PPACA Requirements Apply to a Grandfathered Plan?
For our grandfathered group plans, effective January 1, 2011, the following changes apply:
- A child of the insured who is not eligible for employer-sponsored health benefits on his or her own can be covered under the parent’s coverage to age 26, even if married.
- Lifetime benefit limits on essential health benefits are prohibited.
- Rescission of coverage is prohibited except in the case of fraud or intentional misrepresentation of material fact.
- Preexisting condition exclusions cannot be applied to persons under the age of 19.
- Annual limits on the dollar value of essential health benefits are restricted.
- An internal and external appeals procedure must be provided.
What Changes Cause a Plan to lose Grandfathered Plan Status?
Examples of changes that will cause a plan to lose grandfathered status are:
- Increasing an employee’s premium contribution rate by more than 5%.
- Eliminating benefits for a particular condition.
- Increasing an insured’s coinsurance percentage by any amount.
- Increasing a fixed deductible amount or an out of pocket limit by more than the rate of medical inflation plus 15%.
- Increasing a fixed amount copayment by more than the lesser of $5 plus medical inflation or medical inflation plus 15%.
- Eliminating a plan option.
What Benefit Changes Will Not Cause a Plan to Lose Grandfathered Plan Status?
- Adjusting plan eligibility rules.
- Conducting dependent eligibility audits to ensure only eligible dependents are covered by the plan.
- Adding employees and dependents to the plan.
- Making changes to comply with state and federal law.
- Voluntarily changing benefits to comply with health reform.
- Adding benefits.
- Making changes to dental & vision programs.
- Making changes to the PPO networks.
- Changing insurance carriers, so long as the structure of the coverage doesn’t violate one of the other rules for maintaining grandfathered plan status (amended 11/17/2010).
Non-Grandfathered Health Plans
Under the Patient Protection and Affordable Care Act (PPACA), a “non-grandfathered plan” is a plan that came into existence on or after March 23, 2010, or a previously grandfathered plan that made changes that were significant enough to cause it to lose its grandfathered status. Non-grandfathered plans are subject to all of the new insurance reforms of the PPACA.
What PPACA Requirements Apply to a Non-Grandfathered Plan?
As of September 23, 2010, new non-grandfathered plans must:
- Allow a child of the insured to be covered under the parent’s coverage to age 26, even if married.
- Provide unlimited lifetime benefits for essential health benefits.
- Only allow rescission of coverage in the case of fraud or intentional misrepresentation of material fact.
- Remove preexisting condition exclusions for persons under the age of 19.
- Provide essential health benefits.
“CHIP” Health Benefit Eligibility Notice for All Employees
The U.S. Department of Labor recently issued a model information notice that must be provided to all employees from an employer with a group health plan annually. The notice informs employees of potential state financial assistance to help pay for employer health insurance premiums.
It explains that many states offer premium assistance to employees who are covered on their employer plan but are unable to afford the premiums. Many states use funds from their Children’s Health Insurance Program (CHIP) to assist people eligible for group health insurance but unable to afford their premiums.
The notice includes information on how an employee may contact the state in which the employee resides for additional information regarding potential opportunities for premium assistance, including how to apply for such assistance.
An employer providing benefits in a state that offers premium assistance is required to provide the Employer CHIP Notice, regardless of the employer’s location. Due to the fact that more than 40 states offer such a program, most employers will likely find it easier to simply send the model CHIP notices to all employees, rather than to try to send separate notices to employees based on the particular state in which the employees reside.
An Employer CHIP Notice must be provided to each employee, not just the employees enrolled in the health plan of the employer.
If you have additional questions or would like a paper copy of the notice, please feel free to contact Group Policyholder Service at 800-322-0160, Extension 2814. We are at your service.