Your unique exposures require unique protection. We have been insuring the O&P industry for more than 15 years and have designed an exclusive orthotic and prosthetic insurance program that provides comprehensive protection whether you are a patient care facility, central fab, manufacturer, or distributor.
We have exclusive endorsements with AOPA, ABC, NAAOP, BOC, PrimeCare, and several state chapters for The American Academy of Orthotists & Prosthetists, including OH, PA, NY, FL, and TX. Our professionals can tailor an orthotic and prosthetic insurance program that fits your unique business and budget.
Get Orthotic & Prosthetic Insurance for your:
- Orthotic and prosthetic practice
- Custom fitter business
- Central fabricator business
- Prosthetic manufacturer business
- Post-mastectomy and women's health shops
Protect yourself from:
- Mistakes leading to lawsuits and damages
- Service negligence or harm
- Allegations of misrepresentation
- HIPAA violations
- Billing errors
- Harm or injury caused by products you manufacture, sell, or distribute
- Production, manufacturing, and design defects
- Warning deficiencies and instruction manual errors
- Replacing or repairing broken equipment
- Fiduciary errors, omissions, or breach of duties
- Cyber breach and stolen patient data
- Bodily injury to visitors on your premises
- Injury or property damage caused by your employees
- Employment-related claims
- Damaged, lost, or stolen business personal property
- Lost income from business interruption
- False advertising, slander, or libel claims
- Employee work-related illnesses or injuries
Who is eligible for the AOPA Health Plan?
Member companies in good standing (per AOPA bylaws) may join the AOPA Affinity Health Plan. The benefits are offered to you, your employees, and their dependents.
Why is AOPA offering this?
AOPA is always seeking to improve our member benefits. We saw an opportunity to offer our membership a quality healthcare solution with long term rate stability, built EXCLUSIVELY for AOPA members.
What are the benefits for AOPA members?
This health insurance program was built EXCLUSIVELY for AOPA members and offers you, your employees, and their dependents quality healthcare with affordable monthly premiums and long term rate stability.
What is the process for AOPA members and how does it work?
All enrolling members will submit a Personal Health Questionnaire (PHQ). The PHQs are collected through a secure portal and dropped into a HIPAA compliant database. The PHQ is a summary of your health history. Utilizing the combined history of an organization’s popuation, customized rates can be formulated.
How much does the AOPA health plan cost?
The cost is to be determined after the census gathering portion of the process. There is no way to determine exact rates until the stop-loss carrier can see a sample of the groups, but we have traditionally seen rates anywhere from 10% - 25% lower than the marketplace for comparable products. We also implement a tiered rating system for the plan that helps reach a majority of the groups.
How long are the AOPA Affi¬nity Health Plan rates valid? Can my coverage be canceled at any time?
Plans and rates are good for one year from the initial offering date of 2022. Once launched, the AOPA Affi¬nity Health Plan cannot cancel the coverage during the plan year. Groups will receive advance notice of changes or termination upon renewal, as state and federal laws require.
What networks are available to AOPA plan members?
What if there is an emergency and I go to a hospital outside of the AOPA Health Plan network?
If you are experiencing a true medical emergency then you can go to any hospital’s emergency room. If it is not a true emergency, some restrictions may apply.
Could AOPA go with an Open Network? Could we use Blue Cross or United Networks?
The Reference Based Pricing option is an “open network” program. While members can see a provider in the PHCS network, they can also see any provider and they will be covered.
Can my employees and their beneficiaries be seen at our facility even if we are out-of-network?
Employees are covered at their own facility or that of their spouse or parent.
Can my employees or I continue the treatment plans that have been authorized by our current carrier if we switch to the AOPA Health Plan?
When switching to a new health plan, you must go through the authorization procedures of the new plan. Through a partnership with My Advocate Pro, the AOPA A¬ffinity Health Plan has a team of highly trained consumer advocates ready to assist with the process.
What does the AOPA Health Plan cover? Does the health plan include dental coverage?
The health plan covers all essential coverages required by the ACA as any carrier product. The health plan does not provide dental but it can be purchased as a separate benefit from your agent.
Is there an open enrollment period for the AOPA Health Plan?
The open enrollment period will be 30 days prior to launch (1/1/22) and 30 days post-launch (1/30/22).
Can an individual employed by an AOPA member enroll individually or is this benefit only available to AOPA member companies who would enroll their employees?
The plan is offered at the AOPA member company level, not the individual level.
Is there a minimum number of employees tha need to be enrolled in the AOPA Health Plan?
The plan requires two eligible employees to enroll. Those employees can be related.
How does the AOPA pharmacy discount card work? ($7,350 plan only)
On the $7350 deductible plan there is an integrated Rx/pharmacy card. This allows members access to discounted pharmaceutical pricing that will seamlessly accumulate towards a member’s annual deductible. Discount cards are integrated with the PBM so AOPA members do not have to worry about keeping track of a separate bene¬fit card. Show your ID card at the pharmacy counter and let the AOPA Affinity Health Plan do the rest. This is exclusive to the $7350 Plan as drug copays are generally cheaper on the lower deductible plans. In many cases, the discount pharmacy card has less expensive tier 1 & 2 generics for members.
Are these AOPA plans subject to the Employee Retirement Income Security Act (ERISA)?
Yes, these plans are subject to ERISA.
Can AOPA members utilize their local broker to obtain his coverage?
That is not an available option at this time.
Is O&P coverage included in all AOPA plans offered with CIGNA?
Yes, Orthotics & Prosthetics are covered at 80% after deductible for all plans.
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