Premium Saver FAQs
Updated April 2024
1. What are the participation requirements?
Every participant, including dependents, covered by the group’s major medical plan(s), must participate, and be enrolled with Premium Saver. If a group currently has a dual-option medical plan, including an HSA, those employees covered by the HSA do not have to participate. There are no age restrictions.
2. What is the minimum group size?
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In Florida
- The minimum group size for AmFirst Insurance Company is 2 enrolled.
- The group size for Monitor Life Insurance Company of New York is 2 to 50 enrolled.
- The minimum for Standard Life & Accident Insurance Company is 51 eligible.
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In Massachusetts:
- The minimum group size is 51 eligible.
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All Other States
- The minimum group size is 2 enrolled.
3. What expenses are eligible for coverage?
Any expenses approved by the major medical plan and applied to the major medical deductible and coinsurance except for the professional fee in a doctor’s office or medical clinic and outpatient prescription drugs.
4. What are "professional fees of a physician in a doctor’s office or medical clinic"?
The professional fee of a physician is simply the fee charged by the physician. The professional fee is a covered Premium Saver expense except when incurred in a doctor’s office or outpatient medical clinic. The professional fee and the location of the service will be indicated by certain codes on the major medical explanation of benefits (EOB). Examples of professional fees not covered are the doctor’s fee in a doctor’s office visit or the psychiatrist fee in that office. Most agents pair the Premium Saver with a major medical plan with copays for doctor’s visits and outpatient prescriptions.
5. What about other expenses such as x-rays, labs, crutches, and chemotherapy in a doctor’s office?
These expenses are covered by Premium Saver if they are covered by the major medical plan.
6. How does the Premium Saver administrator know what the major medical plan covers?
The major medical explanation of benefits (EOB) provides that information. The EOB provides the approved charges and how much is applied to the member's deductible and coinsurance.
7. What is the easiest way to get a claim paid?
Have the provider file the claim for the insured. Remind your member to present their Premium Saver card along with their major medical insurance card.
8. What if the provider will not file electronically with Premium Saver?
The member can file the claim directly. Once the major medical plan has processed the claim the member can send in their major medical EOB along with an itemized bill to MWG Administrators or upload on the Client Portal.
9. Why does MWG need the itemized bill in addition to the EOB?
The provider’s itemized bill includes additional information (provider address & tax ID #) to ensure the payment is sent to the correct provider.
10. Can the insured send in the EOB and itemized bill?
Yes, but payment will only be made to the provider, unless the insured proves they have paid the provider in full. Most claims issues occur when the insured files the claim. They frequently do not send in both forms or they send incorrect forms.
11. Will Premium Saver cover out-of-network charges?
Premium Saver pays the same for in or out-of-network charges. This is a front-end advantage for the insured. While most major medical plans increase the deductible or coinsurance for out-of-network charges, Premium Saver does not. Premium Saver is designed to fit the in-network risk with a built-in benefit amount or in-network expense, not the higher out-of-network risk.
12. Does the Premium Saver have a deductible cap?
Yes, the Premium Saver allows for a deductible cap. The Premium Saver deductible can be per person or cap at two per family.
13. Can an agent offer employees more than one Premium Saver plan design?
Yes. A minimum of 10 enrolled is required to offer two plans, and a groups with 25 or more enrolled can select up to 3 Premium Saver Plans.
14. Can Premium Saver be designed to cover occurrence copayments (emergency room, hospital admission, surgery)?
Yes, contact your MWG Broker Services representative for a proposal.
15. What is Prior Plan Deductible Credit?
This is a credit for any deductible met in the current calendar year to prevent a member from having to meet two deductibles during the first year the Premium Saver is effective.
16. What is the best way for a group to receive credit for the Prior Plan Deductible Credit?
Simply submit a report from the major medical carrier with the initial enrollment or within the first 30 days of coverage.
17. Does Premium Saver provide an end of year deductible rollover credit?
No, the Premium Saver does not offer deductible rollover credit.
18. What is the Professional Fee of a Physician Rider?
This rider covers the charge for a professional fee in a doctor’s office or outpatient medical clinic. After the member pays a copay, the rider covers the professional fee until the maximum number of visits is met or the Premium Saver benefit is reached. There are two options available: $30 copay with a maximum of six visits or a $40 copay with a maximum of three visits.
19. Is the Professional Fee of a Physician Rider per person or per family?
The number of visits is based on per person visits per benefit year. If there are three members in a family, each person gets six visits, totaling eighteen visits in one benefit year if each member uses the maximum per person visits allowed.
20. Is the Rx rider administered by MWG Administrators?
No. Rxedo is the administrator of the Rx riders. There is no affiliation between Premium Saver carriers and Rxedo.
21. Does the Rx annual maximum apply to Premium Saver?
No.
22. Does the Rx annual maximum apply to the major medical MOOP?
Yes. If the pharmacy files Rxedo secondary, it will apply. If the pharmacy files Rxedo primary, it will not apply.
23. Does the Rx plan cover injectable drugs?
No, except for insulin.
24. Is there a mail order service with the Rx riders?
Yes, through Walgreens Mail Service. Visit www.WalgreensHealth.com for more information.
