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Contact us about taking control of your Group Health Insurance!

Level Funded and Self-Funded Plan Options

We bring unique specialization in Level Funded and traditional partially Self-Funded health plans. A significant cost driver in both Level Funded and Self-Funded health plans is Reinsurance (Stop Loss), and we bring unique expertise and value to this critical component.

-          Unique Reinsurance relationships

-          Unique Reinsurance contract provisions

-          Unique underwriting flexibility – we understand that an employer transitioning from Fully-Insured has limited access to claims information:

-          Unique Reinsurance contract provisions

Unlike the Fully Insured or insurance carrier driven Level Funded products, our Model is designed to maximize plan surpluses which are 100% retained by the Client.

Plan Administration

Technology platform allows for the flexibility of various plan design approaches.

-          Level Funded – diverse plan designs to select from based on actuarially efficient modeling

-          Traditional Partially Self-Funded – ability to match current plans and customize plans to unique design specifications

-          Medical and Prescription benefits directly integrated with Health and Wellness initiatives

-          Numerous plan formats – PPO, EPO, HMO look alike, QHDHP, MEC

-          Private Exchange Solutions

Provider Networks

-          National carrier networks

-          Regional PPO networks

-          Direct contracted networks

-          Reference Based Pricing Models

Prescription Benefits

-          Elimination of egregious “spread pricing” as a profit center – common among insurance carriers and TPAs

-          Proactive formulary management to combat increasing specialty and brand name drug costs

-          Engaged Health Management for medication adherence

-          Preventive Care and Over The Counter drug lists

-          Specialty prescription management

Client Customer Service

-          Concierge style customer service - no phone tree bureaucracy and customer service black-holes

-          Dedicated client management

-          Dedicated eligibility and claims specialists

-          Monthly reporting reviews

-          Quarterly client plan performance reviews

Health Management / Wellness

-          Compliance incentives integrated directly into the Medical and Prescription benefit plan designs

-          Health Management program members receive free condition specific digital monitors such as glucometers and blood pressure monitors

-          Health Management and Wellness programs reward achievement not participation

-          Proactive Large Case Management, Utilization Review, and Precertifications

-          24/7 Nurse Line

-          Wellness Lifestyle Coaching

Technology

-          Cutting edge technology – our systems are not repurposed 1990’s programming code

-           Claims system is a hybrid of Boolean logic and table driven

-     Online member portal including EOB access

-     Online employer administration

-         24/7 Nurse Line

For more information, please see the following documents:
Performance Health Overview.pdf
PH - Level Funded Overview Website.ppt

Call US today to learn how we can help you save premium dollars while maintaining a happy healthy workforce!
800-503-7750