Control your benefits. With our self-funded plans, we help each group design and manage the plan that fits their employee population and their resources.
Traditional Self-Funded Plans
Unlike a large insurance company’s one-size-fits-all solutions, our self-funded plans offer flexibility in setting deductibles, out-of-pocket maximums and covered services.
Employer groups with 100 or more employees are ideally suited to benefit from the advantages of self-funded insurance. The employee pool is large enough to distribute risk, and the potential cost savings are significant. Our self-funded solutions can be customized at every turn — to deliver cost-effective benefits and excellent care.
- Choose your plan design. Working with your broker or our account team, develop a plan that suits the unique characteristics of your employee team.
- Choose your network. HealthFirst works with several provider networks to give employees a broad choice of doctors and facilities.
- Determine your level of risk. Our analysts will help you determine your attachment point, the level at which your liability ends.
- Add additional benefits. Vision, dental, and other ancillary benefits can be part of your benefits solution.
- Monitor your coverage. Groups can monitor eligibility and utilization in real time through our portal. Your account team can schedule reviews based on your requests so you’ll know exactly where and how your dollars are being spent.
Level Funded Plans
A simplified health benefits plan that feels like a fully insured plan.
Combining the cost savings and customization of a traditional self-funded plan, our level-funded plan offering – Cap Select, feels like a fully-insured plan for small companies with 25+ employees.
With CAP Select, groups pay just one set monthly fee covering administrative costs, stop loss premiums and claims funding.
- Potential surplus: If claims are lower than projected, a reserve can accrue by the end of the contract term – providing companies with funds that can cover other benefit-related costs.
- Limited risk: If claims are higher than projected, extra costs are covered by stop-loss insurance, which is included in monthly premium.
- Fewer fees: Governed by ERISA rules, plans escape many state-mandated benefits, state regulations, and premium taxes that add unnecessary costs to a health plan.
- Transparency: Full access to plan’s claims experience is available.
- Flexibility: Select deductibles and out-of-pocket limits.
Minimum Essential Coverage Plans
Providing basic employee coverage shouldn’t be complicated or expensive.
Our SimpleSelect product is a good option for employers where benefits are not traditionally offered and the employer has many lower-wage or PRN employees.
A self-funded preventive health plan, SimpleSelect meets the minimum essential coverage requirements of the Affordable Care Act (ACA). SimpleSelect provides a way for employers to offer affordable benefits, including free preventive care, while complying with new healthcare regulations.
Available for groups with at least 50 full-time and benefit-eligible employees, SimpleSelect is a value-priced plan with many advantages:
- Self-funded design; avoids taxes and regulations applied to fully insured products.
- Provides preventive care required by the ACA, including common screenings for heart problems, diabetes and cancer; routine vaccinations; tobacco cessation programs and more.
- Affordable: SimpleSelect allows employers to offer a needed benefit to employees, at a cost that’s far below the penalties that would be applied due to non-compliance with the ACA.
- Level 1: Basic plan covers preventive care only.
- Level 2: Provides a greater value than typical MEC plans, with up to four physician visits annually for each participant, at a low copay; generic drug plan with a $2 copay; and unlimited access to telemedicine service.
- Level 3: Adds additional benefits, such as emergency room care.
The same principles that make self-funding attractive for medical benefits can also work for dental plans. We can design and administer a self-funded dental plan that allows employer groups to offer a valuable benefit that employees like and use – at an affordable, predictable cost.
HealthFirst builds and manages self-funded dental plans that can match the benefits currently offered under a fully insured plan, or can be custom-designed to match client needs and resources.
How it Works
In a self-funded dental plan, the employer pays only administration fees plus services actually provided. This can provide significant savings over a fully insured plan, in which premiums remain the same no matter how much dental care is used. Nationally, dental claims average only about $400 per person per year, and statistics from the American Dental Association show that about 30 percent of insured adults do not visit the dentist annually.
- Immediate Savings. In an average year, a self-funded dental plan will cost about 20 percent less per year than a similar, fully insured plan.
- Low Risk. Because it isn’t necessary to include hospitalization or other high-cost services, dental plans have a low annual limit on expenditures per person – typically, $1,000 to $1,500 per person. This means employer risk is very low. Plus, unlike most self-funded medical plans, self-funded dental plans do not require the purchase of stop loss insurance to cover the risk of claims being much higher than anticipated.
- Self-Funded Savings Apply. Enjoy the same financial advantages as with a self-insured medical plan: No premium taxes, avoidance of high premium increases, and better cash flow due to the pay-as-you-go approach.
- Better Health And Well-Being. Good dental health is linked to good overall health. People with serious gum disease are up to 40 percent more likely to have a chronic condition, and poor dental health has been linked to serious illnesses including heart disease and diabetes. Encouraging good dental care can help plan participants identify and manage other potential health problems.
WE MAKE HEALTH PLANS OUR BUSINESS. SO YOU CAN CONCENTRATE ON YOURS.
Plan administration is all in the details. When you choose an administrator to manage your healthcare benefits, you want a team who will take care of your staff – and your healthcare dollars – as if they were their own.
Our TPA team specializes in detail-oriented, personalized service.
- Each group gets a dedicated account management team, you’ll always have someone who can answer your questions and resolve concerns.
- Our cutting-edge technology means you’ll have access to the data and reports that show how your plan and your dollars are being utilized.
- Customized benefits communications are available for employers and employees.
We understand that having a great benefit plan helps to attract and retain the best and the brightest.
Our TPA Services
As the landscape of healthcare has changed, so have the expectations for customer service. Our experienced representatives are available to answer questions via a toll-free number. Their goal is to eliminate stress and confusion from the benefits experience. With a culture of stewardship, they strive to help everyone in the healthcare system work together better. This starts by putting our clients, members, producers, and healthcare providers first. Our team is empowered to resolve most issues on the first call.
Available 24/7 with up-to-date information is the HealthFirst portal for members, HR teams and providers. Key plan information is right at your fingertips, including real-time tracking of benefit usage and deductible status, EOBs, status of claims and more.
Utilizing technology, our advanced and robust analytics can capture clients’ data and help find new opportunities within their company that help to reduce benefit spends and help employers and employees get the most from the money they spend on health benefits. The reports can help companies identify health plan behaviors based on demographics, stay ahead of high cost claimants, spot higher than average uses of emergency room visits plus many other factors. Trends can be identified that trigger programs and activities that can be introduced to lower health costs, manage chronic conditions and lead to a healthier workforce.
It’s not just about the reporting, but understanding the data to allow clients to understand how their plan is performing, allowing them to make more informed benefit plan decisions.
Clients can also choose to have Administrative Services Only (ASO) agreements. An ASO is an arrangement in which a company funds its own employee benefit plan, such as a health insurance program while purchasing only administrative services from HealthFirst. This alternative funding option is a group health self-insurance program often used by large employers who opt to assume responsibility for all the risk, remaining exclusively liable for all financial and legal elements of the group benefits plan.
Typical services offered in an ASO situation can include, but are not limited to:
- Processing claims
- Evaluating claims
- Paying benefits
- Managing COBRA, HRA, FSA, and the like
- Managing benefits enrollment
- Determining benefits
- Preparing summary plan descriptions
These tasks in the hands of someone outside your company also eliminates the need to hire a dedicated group health insurance employee, and eliminates the need to pay another full salary and benefits.
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