What is The Tri-Share Program?
The Tri-Share Program is a community-sponsored and subsidized health program operating exclusively in Genesee County with a Board of Directors representing the local health delivery systems and public health organizations. The mission of the Tri-Share program is to improve the health of the uninsured residents in Genesee County.
How do employers and employees qualify?
* Employers with 2-50 employees who employ workers earning $14.50 per hour or less may qualify.
* Employers must offer Tri-Share Program to all eligible employees.
* Eligible employees must be scheduled to work a minimum of 20 hours per week averaged over the last 90 days prior to enrolling the Tri-Share Program.
* Employee and his/her eligible spouse may not have any other group sponsored healthcare coverage at the time of enrollment in th eTri-Share program or be eligibile for Medicare or Medicaid.
* Employees that are covered under a Major Medical plan and do not have their dependents covered under the plan can enroll dependents under Tri-share if they meet the above eligiblity criteria for the employee.
* Employer's business must have been operational for at least 6 months prior to enrolling in the Tri-Share Program.
What are the advantages to the small business owner?
Tri-Share is a high-quality, affordable, indemnity group healthcare program, featuring more comprehensive benefits than other programs currently available. Tri-Share is a full coverage program — and includes hospitalization.
There are no census requirements, complex participation requirements, COBRA issues or required meetings.
What are the advantages to the employee?
Tri-Share is a full coverage program. For about $53 per month an employee can have the following benefits:
- Physician office visits
- Outpatient prescription drugs
- Lab and x-ray
- Hospital emergency room benefit
- Ambulance benefit
- PPO discount network
- Hospital confinement, plus intensive care benefit
- Surgery and anesthesia
As an added value Tri-Share includes Term life and accidental death and dismemberment coverage at no additional cost.
Most services have yearly limits but there is no deductible and no co-insurance. It’s easy to use and easy to understand.
There are no pre-existing limitations or exclusions and no physical examination is required.
How do interested businesses or employees get more information?
By calling 1-877-TriShar (1-877-874-7427) or emailing our enrollment agent at ashliec@securityfirstbenefits.com
How are claims processed?
Benefits will be paid directly to the physician or hospital by the plan. If the billed amount exceeds the plan specific benefit amount, the provider will bill the employee for the difference. Some providers will require that the entire bill be paid up-front. In such cases, the employee can obtain a claim form from our website (or your office) and would submit it along with valid receipts to KBA for reimbursement. You will find the information for submitting a claim on your claim form. Claims processing will typically be initiated within 10 working days of receipt. If you have a question about your claim, call 866-387-3402 between 8:30 AM and 7:00 PM EST.
Will employees get insurance cards?
Yes, a card will be issued once the enrollment has been approved.
When is Coverage Effective?
Your employer selects the effective date and your effective date of coverage will be stated in your Benefit Summary and Outline of Coverage.
Who should consider enrolling in The Tri-Share Program?
The decision should be based on a combination of affordability and coverage needs. The claims stratification graph provided herein shows that the majority of annual claims, or 81%, are under $2,500. Therefore, The Tri-Share Program has been designed to meet basic and most important healthcare needs.