Friday, May 11, 2012

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and sometimes even meet their out of pocket maximum. healthy males that rarely go to the dr. they are now realizing that if they leave the employer group plan they can more-than-likely get cheaper or maybe even better insurance by going to an individual policy This causes what we in the industry call an "Adverse Selection" situation This means that only the 'sick' or employees that really utilize the plan are sticking around With the healthy employee population pulling out of the group plan it means sick money in against sick money out There is no way that renewals can do anything other than skyrocket in this type of scenario This is a direct effect of the 80%/20% rule 80% of an employer's claims experience is driven by only 20% of that same employer's employee population This means that with 20% of the employee population truly utilizing the plan there are approximately 80% of the employees that are not getting a 'true' benefit out of the benefit plans being offered It is absolutely necessary to keep the single young healthy males as part of the employer sponsored plan Their involvement will help to offset the premium being paid by the carrier for the 'sick' or over utilizers of the plan With this plan there truly is a 'benefit' for everyoneControlling Medical Costs As medical costs continue to rise employers are looking for opportunities to save money and control future cost The HMO/HRA combines the most popular features of typical HMO plans ie copays for office visits with consumer features that help employees increase their understanding and control of their personal health care spending In conjunction with online tools and support employees can save money by making better decisions around the purchases they make on health care Furthermore the features incorporated in the HMO/HRA provide health coverage employees need at a premium cost that's beneficial to the employer When looking at an HRA/HMO plan consider the following plan benefits: A Health Reimbursement Arrangement (HRA) fund Traditional HMO medical plan Various pharmacy rider options Consumerism tools and information"There are only 5 services for which the fund applies so most of the services are available for only a co-pay So if you put a 100% $750 deductible HMO/HRA w/a $250 fund in place the employee's max OOP would be $500 ($250 fund + remaining $500 balance of the $750 deductible) before Hospitalization goes to 100% coverage Hospitalization is the key word here as that is usually the big ticket item w/health insurance Now all of a sudden you have an HMO that offers an extremely low OOP Max for the 'utilizers' and a plan that builds for an unfortunate future 'rainy day' for the employees that barely utilizeThe 5 deductible services are as follows: 1 Emergency Care 2 Hospital Care 3 Outpatient Surgery 4 Home Health Care 5 Durable Medical EquipmentThe Health fund could range from $250 to $1000 for individuals and $500 to $2000 for families In relation to the fund it will reimburse covered services and supplies that are applied to the plan's deductible "Copays are not eligible for fund reimbursements just like a regular HMO as they are not applied to the plans deductible and all fund reimbursements for covered eligible expenses are sent directly to members At year's end any unused fund balance rolls over to the next year and a new 'fund' is applied for the new year allowing the balance of the fund to grow annually This plan is good for the employer too as the members forfeit any unused balance when they either leave the employer or discontinue participation in the planNot only is the plan quite unique but with the majority of the employees remaining within their 'fund' for the year the renewals are significantly lower too A true win/win you'll want a plan with a generous provider network that includes access to physicians in many states. mountain climbing,human anatomy courses, 416 medical offices and 13,500 employees as of 2010. 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