The Essential StaffCARE 5500 plan is a fully insured plan that provides comprehensive coverage as outlined under the Affordable Care Act (“ACA”) to full-time employees working a minimum of 30 or more hours per week.
Choosing a health coverage plan is an important decision. To help you make an informed choice, your plan makes available a Summary of Benefits and Coverage (“SBC”). The SBC summarizes important information about the Essential StaffCARE 5500 health plan in a standard format, to help you understand plan benefits. The SBC is available by visiting www.paisc.com or by contacting customer service at 1-866-798-0803.
You are eligible to enroll in the Essential StaffCARE 5500 plan within 30 days of your eligibility date or during your employer’s annual 30 day open enrollment period. You may enroll you and your children up to age 26 (or state mandate). In order to participate in this plan, you must sign up during the open enrollment period. If you miss this date, you and your dependents will have to wait until the next open enrollment period or until you have a Qualifying Life Event. You have 30 days after the date that triggered the qualifying life event to purchase major medical health insurance coverage for yourself and your children. A qualifying life event is defined as a change in your status due to the following:
- Marriage or divorce
- Birth or adoption of a child (children)
- Death of an immediate family member
- Employer bankruptcy
- Loss of dependent status
- Involuntary loss of coverage
In addition, you may request a special enrollment for yourself and your eligible dependents within 60 days of the following:
- Termination of coverage under Medicaid or a
- State Children’s Health Insurance Program (SCHIP)
- Becoming Eligible for SCHIP Premium assistance under this medical benefit
Once enrolled, you may contact customer service at 1-866-798-0803 for questions regarding plan coverage, ID cards, claim status, policy booklets and to add, change, or cancel coverage.
Deductibles and Maximum Benefits
Deductibles and maximum benefits are based on a coverage year (January 1–December 31). If dependents are covered under the plan, each dependent must meet a deductible and is subject to the annual maximum benefit.
This employer sponsored plan is renewable at the option of the policyholder. It may not be purchased as an individual policy. This form is intended as a brief summary of the coverage provided. The group policy issued to your employer is the official document governing the provisions of the Essential StaffCARE 5500 benefit plan. State mandated benefits that apply to this plan will be included even if they are not described herein. Your health insurance ID card will be sent in the mail along with information on how to access your Summary Plan Description (SPD). If you are age 65 or older, or if you or your dependents are eligible for Medicare and you are enrolled in the Essential StaffCARE 5500 plan, please contact your Human Resource Department for the Medicare Part-D notice.