Are You Frustrated With Your Health Benefits?
Many frustrations with healthcare hinge on inadequate health insurance coverage, the confusion with navigating insurance barriers to access, and the unexpected expenses and coverage issues patients experience.
RISING PREMIUMS
NO PLAN TRANSPARENCY
ADVERSE PLAN DESIGN CHANGES
LIMITED ADVICE ON HOW TO CONTROL COST
LACK OF INFORMATION ON SELECTED PLANS
What Makes Andus Different?
Unbundled Plans
Alternative Funding Platforms
Plan Transparency
What is an Unbundled Plan?
At first, buying a bundled plan can seem easier and more straightforward, but lack of control and transparency can affect cost and employee utilization long term. For example, an employer has no way of knowing how each vendor fee compares to market costs because in a bundled plan those fees are often hidden or combined together.
When a plan is unbundled an employer has the opportunity to contract with specialized companies who manage different parts of the program. By separating services an employer can select the best vendor for each service, gaining transparency and flexibility within their plan to better manage costs.
What is alternative funding?
Alternative Benefit Funding is a new approach to group health insurance that allows mid-sized employers to take advantage of the same economic benefits that large, self-funded employers have utilized for years.
Alternative Benefit Funding is a form of self-funding that functions very similarly to an insured policy where the employer pays a set monthly amount based on the claim level they have chosen to fund to. But unlike an insured policy, the employer shares in a portion of the unused claims funds, after claim payments and plan costs. This approach allows even small employers to establish a monthly health plan budget and take advantage of the economic benefits of self-funding that many large employers have enjoyed for years.
How can Andus save us money?
With a strategic plan in place your business can begin to unlock savings by unbundling your health plan. Some services of a plan that can be unbundled are,
- Pharmacy benefit manager (PBM). A pharmacy benefit manager’s main purpose is to reduce spend and increase access to medication. PBM’s have the ability to negotiate prices with many retailers and manufacturers, giving them the ability to pass discounts to employers and employees. When a PBM is unbundled from a provider, an employer gains insight into what medications are being offered, and how much they cost.
- Third party administrator (TPA). A TPA is a company that provides administrative and operational services, such as processing claims and complying with regulations. By unbundling your TPA you can gain a dedicated plan administrator who will monitor your plan proactively.
- Utilization review/case manager. With a focus on utilization, a case manager can reduce costs by reviewing claims made by employees and identifying any services that may not have been necessary. A case manager can also help ensure compliance to regulations.
- Network. A provider network includes doctors, hospitals and medical facilities that a plan contracts with to provide medical care to members. The providers included in a contract between an insurance company and employer are referred to as “in-network providers.”
At Andus, we work with you to develop a clear, strategic plan that can uncover hidden fees and create flexibility to truly design a plan that your people need. Unbundling your plan doesn’t have to mean making drastic changes. When making any changes to your benefits plan we take the time to analyze necessary data, make recommendations and answer any questions you may have.
Part of our focus when adapting benefits is on employee education. Whether the entire network changes, or only your pharmacy benefit manager. Helping your people better understand their health plan and why those changes were made is crucial to reduce any disturbances.
If you have questions about designing a health plan that better suits your unique workforce, let’s chat! Every company is unique and we can meet you where you are.