Employers: Looking for a way to save money yet provide benefits to your employees? Looking for ways to support employee retention?
We now work with a company who offers a variety of self-funded health insurance plans. These plans help save employers up to $270, per employee, per month. These plans include a complete health insurance and direct primary care package that is tailored to an employer's needs. Call us at 606-831-6168 today for more information.
Would direct primary care just be an added cost to our plan?
DPC should be viewed as an investment that will provide a return when your company finds that the need for more expensive downstream healthcare services, like hospitalization, ER, specialist care, and pharmaceutical costs are reduced in response to highly accessible and high-functioning primary care.
Consider adding Advanced Primary Care memberships for your employees. By offering same-day or next-day appointments, high quality and convenient primary care to your employees, we can help reduce absenteeism and expensive Urgent Care or ER visits. We also focus on prevention and wellness which decreases sick days and adds to the productivity of your company.
How is this different than an on-site clinic?
A traditional on-site clinic continues to bill the insurance plan in addition to charging an annual fee. Many onsite clinics are “behind the fence” and don’t allow spouses/dependents to access care. Also, many have traditional business hours and don’t offer after-hours access.
Is there a long-term contract?
This depends on if you are using DPC alone or with an insurance product. Additionally, if providing DPC to your employee population requires that we build a new clinic or hire a new physician/provider, we may require a 1+ year contract. If DPC is not used with your current insurance, the agreement is typically month-to-month.
MEC is an acronym for ‘minimum essential coverage’. A MEC-compliant plan covers the preventive benefits (found here: https://www.healthcare.gov/coverage/preventive-care-benefits/) that a qualified health plan is required to cover so that: Individuals are exempt from paying the individual mandate penalty, and large employers may avoid the “non-offering employer” or “sledgehammer” penalty.
Self-insured employers pay for each out-of-pocket claim an employee makes as they are incurred instead of paying a fixed premium to an insurance carrier, which is known as a fully-insured plan. The payment of claims can be smoothed and made predictable by financing mechanisms.
Typically, a self-insured employer will set up a special trust fund to earmark money (consisting of corporate and employee contributions) to pay incurred claims. This is the definition from the Self-Insurance Institute of America, Inc.
When self-insured, how do employers shield themselves from unpredictable and catastrophic claims?
Self-insured employers may buy re-insurance called ‘stop-loss insurance’ to reimburse the company for claims above a set dollar amount that the employer may choose.
What’s the minimum company size for self insuring?
When you have 5 or more employees you can consider self-insuring.
What steps need to be taken to implement a self-insured plan? Who could set it up and administer it? Is it difficult or time-consuming or are there hidden costs when setting up a self-insured plan?
A third-party administrator (TPA) or benefits broker will be your hub to connect you with other parts of your health plan, like a physician network, pharmacy benefits manager, nurse helpline, etc. The third-party administrator will also administer the plan. Request a transparent third-party administrator to make sure that there are no hidden costs.
Do employees have to give up their current primary care physician?
Employees do not need to give up their current PCP.
What are the downsides/risks of self-funded insurance and DPC?
There are nuances to self-insuring that don’t exist in the fully insured world. As long as you know where the risks lie, you can prepare for them or circumvent them entirely.
Examples of issues that incompletely informed executives may be surprised by include:
Run-out is how your plan will pay for claims after you have broken ties with your stop-loss provider. For example, if the final date for your plan is 12/31/17 and your employee sees their doctor on 12/30/17, the doctor’s bill will not likely be submitted until after the plan termination, even though the service took place when the plan was in effect. A typical run-out extends out 6 months after your plan terminates. You can contract with your current stop-loss provider to provide the run out.
It is possible that a stop-loss provider can decline to quote a rate for stop-loss insurance. That being said, the employer can request a contract provision that would require a quote from the existing stop-loss provider.
A laser is used when a stop-loss provider wants a different (higher) level of stop-loss for a particular individual. In this situation, the employer would be asked to pay for all claims below the stop-loss level.
DPC is relatively risk free. The rate is capitated (a medical provider is given a set fee per patient) and the services and fees are transparent.
As an employer, you can offer Advanced Primary Care memberships to your employees as part of their benefits package, with or without incorporating the self-funded health insurance plans. Our memberships are affordable and flexible and may be paid partially or in full by the employer OR they can be paid by the employee.
In addition to comprehensive primary care services, we provide comprehensive workplace health services, including: