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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