Medical Benefits

The MarineMax Healthcare Plan is a Self-Insured Plan. Self-Insuring is an arrangement in which your employer funds all medical expenses and contracts with a Third Party Administrator (TPA) to provide administrative services and process claims for the group’s medical benefits plan.

Being Self-Insured allows MarineMax the benefit of implementing the plan design and choosing benefit options that meet the needs of our team by having access to “best in class” services from multiple vendors. Most fully-insured plans offer “canned” programs which limit services and requires the employer to relinquish control of one of the most expensive components of their operation.

There are numerous unique and innovative components to the MarineMax Healthcare Plan. We urge you to review this information carefully to ensure you get the best care at a reasonable cost.

The administrator of the MarineMax Healthcare Plan is Imagine360, formerly Group & Pension Administrators (GPA). Imagine360 provides all administrative services and processes all medical claims. Imagine360 also offers a number of other services to our team. These include:

Member Experience Team can assist with health plan benefits by obtaining medical records for appointments, researching physician quality and credentials, locating provider options for medical services, scheduling appointments, and coordinating provider negotiations. Registered Nurses on staff are available to provide guidance and education, as well as facilitate continuous patient support and case management. The contact information for The Member Experience Team is included on your insurance card.

This portal provides a streamlined, easy-to-navigate platform to access all of your health insurance information. View Link. You must provide your group number: #H870879

This app puts the most popular online features at your fingertips.

Imagine360, formerly ELAP Services – ERISA LIABILITY ASSURANCE PROGRAM. Imagine360 is a co-fiduciary of our Plan and it is their responsibility to ensure Plan Assets are appropriately managed.

Imagine360 provides a Cost Plus Audit Program (Facility Charges) significantly reducing health care costs without impacting the quality of care.

Imagine360 audits and reprices each facility (hospital, in/outpatient surgical centers) claim based on audit results and claim limits. Each claim is also audited for errors and unexpected or incorrect charges. All claims are processed through Imagine360.

Claims are repriced applying the Cost Plus method in accordance with our plan. Claims are paid at the greater of:

Hospital Cost to Provide Service + 12% OR The Medicare Rate + 20%

Services are paid at a Cost Plus Margin Basis (Bottom-up) rather than a percentage off overinflated charges (Top-Down). To date, this plan has saved our company and you, our team members, several million dollars in medical costs.

Should you receive a “balance bill” from a facility you are instructed to send it to Imagine360 as soon as possible.

If Member Receives a “Balance Bill” – Send Directly to Imagine360

Imagine360 Facility

Facility Receives Payment

MultiPlan Network – Physician Claims

MarineMax has implemented the MultiPlan (Practitioner & Ancillary) Network of physicians. The MultiPlan Network logo is on the front of your ID card. To locate providers participating in MultiPlan’s networks, visit multiplan.com

Team Members may continue to see physician(s) of their choice, outside of any network. Physician claims outside any network will be audited and repriced by Imagine360 and paid in accordance to the plan reimbursement schedule below.

• Generalist (Primary Care): Medicare + 40%

• Specialist: Medicare + 55%

• Anesthesiologist: Medicare + 100%

• Labs, DME, Other: Medicare + 25%

Should you receive a “balance bill” from a provider, you are instructed to send it to Imagine360 as soon as possible. On average, less than 1% of claims are balance billed.

DO NOT PAY ANY AMOUNT ABOVE THE AMOUNT ON YOUR EXPLANATION OF BENEFITS (EOB) RECEIVED FROM IMAGINE360

Beginning January 1, 2023, if you reside/work in the Imagine Health Network footprint — you will have access to both Facilities and Providers in the Imagine Health Network.

To locate a provider in the Imagine Health Network, go to www.imaginehealth.com/provider-search. The Member Experience Team can assist you with navigating the website with any of the available Networks.

Detailed Summary of Benefit Coverages (SBC’s) are available on Jostle.