The year is 2009, my good friend Mark Gaunya, of Borislow Insurance co. writes the book “Bend The Healthcare Trend“. In 2017 the second edition is printed. Why is this subject so important? Believe it or not, companies from 5 – 5000 employees can “Bend The Healthcare Trend”. How you ask? Partial self-funding. My clients have benefitted from partial self-funded plans for the last 25 years. Aetna and UHC (United Healthcare) now offer these plans. Other plans are out there that use National PPO networks, combined with an administrator and competitive stop loss and reinsurance put you in the driver’s seat, not the insurance company.
Read on I will provide some examples, first a brief review of the benefits of this funding method for employers and their human capitol, their employees. One benefit, groups under 50 receive composite rates for all tiers. All plans come with Telehealth and Nurse assistance programs, separate pharmacy vendors that watch every prescription that your employees fill to make certain the employee and your plan is receiving the lowest price out there. One of the entities that I work with brought out a new plan this year. The plan is a zero deductible and zero copays. The real benefit of this plan, “Call the Nurse” you will be directed to the best Guided Network (yes a National PPO network) providers in your area for the most appropriate care when you need it the most. The goal of this plan is to control costs and provide your employees with providers that practice “Evidence -Based Medicine”. Evidence Based Medicine means that the course of treatment you receive has been scientifically tested, reviewed by medical peers, and confirmed to be safe and effective for a given condition. There is always risk involved in medical treatment, but with Evidence-Based Medicine, experience, data and the power of numbers guide best practices.
The following example is one of the most rewarding ones that I have brought to a client in the last 25 years. Three partners at this client, 65 employees on their health plan. The group had received a 31% increase, (this was 3 years ago) one of the partners refers me into the group. The managing partner had a 15 year relationship with his benefits consultant. The bottom line, quoted the group, premiums were the same as their current premiums, good bye 31% renewal. That saved them $95,0000. Claims savings that first year were $63,000. That equals a total savings of $158,000.
There is a lot of misinformation out there on these types of plans, do not listen do not believe it, investigate this type of funding for your company. Hopefully, this blog does not come across as a big sales story, my goal is to disrupt your thinking and the status quo out there and to “Bend The Healthcare Trend”.