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Hagan Benefits, Inc. / Governmental Pools / HPSD FAQs Q: Why was the health pool created? A: The Health Pool of South Dakota was created to STABILIZE RATES in response to: Proposed health care reforms BC / BS split and SDML request Increasing insurance costs and medical inflation Success of pooling Q: How does the pool work? A: The pool is an insuring mechanism which spreads the risk across a large group. Premium dollars are split between BUDGET (expected claims, reinsurance and administration) and RESERVES (for catastrophic claims). The portion of reserves not used to pay claims is traditionally the insurance company's profit, but in a pool the excess reserves are shared with members.   Q: How does a claim work? A: Claims of less than the reinsurance retention are paid for/shared by the pool. Claims greater than the retention are paid 100% by the reinsurance company.   Q: Will our deductibles rollover from our current insurance? A: Yes, we will honor any deductibles and co-insurance that have already been met.   Q: Do prescriptions count towards your deductible? A: Yes, if you do not have a $15 Generic; $25 Formulary; $35 Non Formulary Pharmacy Card copay. If the group wants the medicine to go toward the deductible then the employee pays full price and gets it applied to their deductible.   Q: What are the start-up fees involved with the pool? A: There is a one-time fee that will vary depending on the group size. This goes to cover the cost of I.D. cards, plan documents and documentation.   Q: How often can we expect rate increases? A: The pool renews every July 1, and if there is to be any rate action it will happen on the anniversary date.   Q: Is a PPO an HMO? A: No, a PPO does not limit you to any doctor or hospital. It simply gives better discounts if you use a network provider. When using the network your copay is 90/10, and out-of-network is 70/30.   Q: What is the enrollment process? A: Step 1. Collect claims history or individual health condition statements Step 2. Determine plan parameters Step 3. Establish rates Step 4. Submit Employee applications Step 5. Distribute plan booklets and ID cards   Q: How do we withdraw from the pool? A: Members join for one year at a time. Withdrawal is accomplished by providing a 60-day written notification. Reserves are returned to the entity one year hence, and the employer is then responsible for ensuing claims.

	Hagan Benefits, Inc. 1741 S. Cleveland Ave, Suite 200 P.O. Box 5090 Sioux Falls, SD 57117-5090 Email: info@hagangroup.com  |  Home  |  Company  |  Services  |  FAQs  |  Resources  |  Contact