Because we believed we could do better than the school district. Because as a pool of large and small school districts we have greater purchasing power to reduce costs and/or improve benefits. Because your fellow members, staff, and leadership control the data to more cost effectively deliver benefits. Because your fellow members, staff, and leadership are your non-profit plan's advocate when you need to appeal any claims decision or plan provision interpretation.
The Public Education Health Trust pool places assets in a Trust for the sole benefit of plan participants. The Trust and the Plan are under the control of trustees elected by the members and/or appointed.
The trustees have set the limit that defines the usual, reasonable and customary charges for services based on an impartial database of the fees. The Plan pays at the 90th percentile of all charges based upon procedure ID code. For example, if 90% of the doctors charge $100 for an intermediate office visit that will be the usual, reasonable and customary fee for that service.
Copies of detail receipts should be mailed to EBMS at the address below. Once a year, EBMS requests that a "Statement of Claim" form be submitted to them for each individual on the plan. This is to verify current information. A download of this form is available on this site on the forms page.
Receipts should include the covered members social security number and clearly indicate if payment is owed to the provider or the member. You may consider attaching a copy of the NEA-Alaska Health Plan insurance card.
There are no additional claim forms required, nor are you required to use specific envelopes. Submit a copy of the itemized receipt to: Employee Benefit Management Services, P. O. Box 21367, Billings, MT 59104
Phone: 1-866-247-1443 or www.ebmstpa.com.
For a variety of reasons, the Plan cuts the middlemen out, middlemen such as agents. The plan employs patient advocates to seek the best care for plan participants, which, in the short run may cost a little more, but in the long run, will cost the plan less. The plan harnesses the purchasing power of many large and small school districts to buy lower cost insurance and negotiate discounts with medical service providers.
The plan is a non-profit, any surplus and/or reserves are for the sole benefit of plan participants. Investment income earned on the reserves are used for the sole benefit of plan participants. The plan also purchases cost effective insurance to protect the Plan's assets in the event of adverse claims experience and finally because we pool the costs and risks associated with the Plan among many school district employees.
Our insurance limits the plan's risk to a maximum liability that is covered by contributions for each contract year the policy is in force. All health plans are at risk for increased costs due to medical inflation, fluctuating insurances, premiums, poor claims experience and an aging population. At renewal, the insurance company will review the impact of these risks and present the trust with the required plan contributions necessary to cover maximum liability.
The trustees will solicit bids annually for the best renewal terms. If your collective bargaining agreement allows it and your school district believes it can do better then the Public Education Health Trust plan, it may decide to pullout of the plan and choose another health plan.
Members can get replacement insurance cards, IRS 1095-A forms, and other documents by logging into their miBenefits account. Members may also call the Health Trust (Alaska: 1-888-685-7526, Anchorage: 907-274-7526) office and request a replacement card during office hours.