General Plan Overview

IGA Group Employee Benefit Trust is a benefit trust established by and controlled by the elected Trustees of member employers of IGA Inc. formally known as the Independent Grocers Alliance, Inc. The IGA Group Employee Benefit Trust was established to secure the benefits provided employees and dependents of member employers of IGA Inc. Participation in the IGA Group Employer Benefit plan is contingent upon the employer maintaining membership in IGA Inc.

The IGA Group Employee Benefit Plan provides major medical, prescription drugs, dental, vision or short term disability coverage healthcare benefits for the employees and dependents of IGA Inc. member employers. All benefits provided under the IGA Group Employee Benefit Trust are subject to the Employee Retirement Income Security Act (ERISA) of 1974 as amended including such provisions for COBRA and HIPAA and all other federal benefit mandates. Each employer may select and provide the benefit plan that fits their pocketbook and the needs of their employees and dependents.

Group healthcare rates for each participating employer group are based on the discounted cost of benefits in the geographic area where the employees and dependents reside, their actual age, sex, and family status and the general medical condition of the employer group. Each participating employee receives a Summary Plan Description (rather than an insurance policy) describing all the benefits provided. Each employee receives an identification card showing the selected preferred provider.

The IGA Group Employee Benefit Trust is not in and of itself deemed to be insurance. The Trustees of the healthcare plan however, purchase insurance direct from the world insurance market under one policy to further secure the benefits provided. Under this insurance arrangement all eligible healthcare benefits are guaranteed from the first eligible dollar to the limits set forth in the Summary Plan Description by certain qualified “A” rated Underwriters at Lloyd’s, London admitted to the State of Illinois the domicile of the Trust. . There is no need for a primary domestic insurer, a major savings in itself. While the Plan itself is not covered by any state GUARANTY association, the insurers of the benefit plan are required to guarantee the full amount of all outstanding U.S. claims with security held in trust in the State of Illinois and the United States.

The insurance provided by certain Underwriters at Lloyd’s, London for the healthcare portion of the Plan is provided through R. J. Wilson & Associates Ltd., a reinsurance brokerage house and direct correspondent with Underwriters at Lloyd’s, London and is placed wholesale direct without commission or remuneration paid to R. J. Wilson & Associates Ltd.

Medical Benefits Administrators of MD, Inc (MBA) is the first party and Plan Administrator of the IGA Group Employer Welfare Trust. MBA also provides claims adjudication and processing services on behalf of the IGA healthcare benefit plan. MBA a well known third party administrator employs the latest state of the art information and benefit processing systems.

Group life and AD&D coverage is also available through an “A” rated national group life insurance company. Group life and AD&D claims are handled directly by the insurer.

Read what other grocers are saying about their new IGA Benefit Plan.

Major Plan Features

Major Medical

Comprehensive Major Medical Benefits are provided up to $1,000,000 per employee and their dependents per person per year with a lifetime maximum of $2,000,000 per person. Benefits under the plan are subject to all federal provisions regulations and mandates such as "ERISA", "COBRA", and "HIPAA." Employer group rates are established actuarially based on the demographics of the specific group. Absent general group claims experience, individual medical information may be required at inception but such information is used for group rating purposes only. Additional new employees will be added subject to the rules of HIPAA.

Fully Insured

All healthcare claims are fully guaranteed by certain qualified “A” rated Underwriters at Lloyd’s, London. Under the insurance arrangement the insurers become directly liable to the eligible employer or dependent for the full amount of any eligible claim incurred during the Period of Insurance is not paid within 30 days of final determination under the claims procedures established per ERISA guidelines and set forth in the Summary Plan Description.

Contributions

The base contribution rates are based on the current geographical cost of medical services in the specific zip code of the employees and dependents, modified by the other demographics of the employer group. Overall contribution rates may be adjusted up or down each six months to allow for more accurate rate trending of the cost of medical services and avoid overly conservative long term trend factors and double digit rate increases at renewal.

Preferred Providers

Before you change doctors. We’ll change networks. The IGA Group Employee Benefit Trust has access to several National & Regional PPO networks available. To see a complete list go to our PPO map and/or PPO list.

Utilization

Each employee has access to a toll free line that they may call 24 hours per day, 7 days per week for pre-certification of inpatient, outpatient, and elective procedures, diagnostics, therapies, network guidance, and other needs. The utilization program includes concurrent, and retrospective review, as well as a second opinion program. The benefit plan also includes large claim management services with a focus to facilitate more individualized and coordinated care.

Administrators

Medical Benefits Administrators of MD, Inc. (MBA) is the Plan Administrator and fiduciary under the direction of the Trustees for all benefit plans provided under IGA Group Employee Benefit Trust. MBA assists the Trustees with all federal filing requirements and adjudicates and processes all claims on behalf of the Plan. All administration services are provided by or through MBA for one level management fee to reduce cost. MBA utilizes the state of the art Trizetto Quiclink System (formerly known as Resource Information Management or “RIMS”) in the management of benefit claims. MBA also employs Solucient Auto Audit and other similar systems as well as INGENIX (formerly Medicode) in the administration of claims.

Other Benefits

Optional dental and vision coverage is also available. The IGA Group Employee Benefit Trust also provides a selection of fully insured group life, accidental death and dismemberment coverage written on a true group basis for groups of ten or more. Group Life AD&D claims are handled direct by the group life insurance company.