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Innovative Solutions

Team (8).JPGUnified Plans

A unified plan creates the environment for flexibility and customization. A fully insured employer, “one size fits all” health plan, may be forced to pay for benefits its employees will not utilize and unable to offer other benefits its employees particularly need. Self-Funding and partial self-funded allows an employer group to custom design a cost-effective health plan tailored to specific needs.

For instance, high-cost benefits that employees do not value can be replaced by benefits that employees particularly want, often for a lower cost. An employer group can identify additional cost saving opportunities while custom building a plan that supports objectives, and offers a range of options matching the needs of a diverse workforce.

Plan Flexibility includes:

  • Developing a more cost-effective plan by excluding or limiting benefits while meeting employee needs.
  • Implementing a care management program to direct participants toward the most adequate and cost effective medical care.
  • Assisting clients to develop pharmacy or prescription drug plan management programs that provide detailed analysis of group specific trends and improvements.
  • Offering new alternative health plan options such as consumer directed health plans.
  • Providing coverage for alternative treatment procedures, such as chiropractic services and acupuncture.

Because self-funded plans are not bound by state law, a multi-state location employer group is not burdened by state law requirements and can design and manage a single self-funded plan that fits the needs of employees in diverse locations.

Complete Funding Alternatives

Self-Funding offers several advantages to small and mid-sized employer groups by gaining the same advantages as their larger counterparts when they implement self-funded and partially self-funded healthcare plans.

Financial and Administrative Control

With the advent of the Patient Protection and Affordable Care Act (PPACA), it is said that self-funded plans will experience a 5-10% rate increase over the next 4 years versus the 30-50% increase fully insured plans will incur. When an employer group changes to self-funding it gains control of the healthcare contract and with that control comes the ability to:

  • Operate efficiently and effectively.
  • Detect areas where modification of systems and processes may be desirable or necessary.
  • Make continual improvement in plan operations, with a goal of optimizing plan performance, improving employee satisfaction, and ultimately saving plan cost.
  • Monthly reporting for full transparency.
  • Ownership of your plan’s data to use effectively in managing the underlying health risks.

Imagine opening your documents for next year’s plan and not having sticker shock. We renegotiate with multiple reinsurers for Specific and Aggregate insurance protection.