| |
HMA
Directs' Flagship Employee Benefits Program:
Doctors Choice Health Plan
The Doctors Choice Health Plan is a partially self funded plan that
incorporates stop-loss insurance to protect each company from excess
claims by placing a ceiling on financial risk. The HMA Doctors
Choice Health Plans are governed by Federal Guidelines which are
governed by the Employee Retirement Income Security Act (ERISA).
State insurance departments dictate specific guidelines for the Stop
Loss insurance that accompany these plans. HMA Direct is currently
administering self funded health plans in conjunction with stop loss
insurance that complies with individual state department of Insurance
mandates. While HMA Direct is not an insurance company; as a Managing
General Underwriter (MGU) and a Benefits Consulting Firm we represent
only A- Excellent or better rated insurance companies to provide our
clients' stop loss insurance coverage.
The Doctors Choice Health Plan provides the benefit of passing on the
savings realized when claim costs are low on to each company through
reduced costs. In contrast, under a fully insured plan, the
company pays fixed monthly premiums to an insurance carrier, and the
carrier assumes responsibility for paying claims and the related
financial risk, and retains any savings when claim costs are lower.
A fully insured plan is funded monthly with a fixed amount which is one
twelfth of the annual premium. Alternatively, the HMA Doctors
Choice Health Plan funds claims as they are incurred (or employers fund
set monthly amounts), which allows the company, not the insurer, to
receive a return on unused, over-budgeted claims funds. At the end
of a plan year in which claims have been lower than anticipated, a
traditional fully insured plan keeps the premiums and treats the savings
as profit for the insurance company.
With the HMA Doctors Choice Health Plan, the unused claims funds
remaining at the end of the period covered by the plan and the
applicable run-out period, are passed on to the company as savings in
the form of a credit against the next year's obligations on renewal of
the plan. In addition, the Doctors Choice Health Plan, being a
partially self-funded plan is not liable for state health insurance
premium taxes on the employers claims fund dollars. This tax
savings can amount to 2 to 3 percent of a premium's dollar value. This
is a direct, automatic savings to a company with an HMA Doctors Choice
Health Plan.
In recent years, flexible-funded health plans have grown in popularity
for companies of all sizes and types. This is due in part to
significantly rising healthcare costs, which has caused sponsoring
employers to become more involved in understanding the details of their
health benefit offerings. As more employers understand the
dynamics of fully insured plans versus flexible-funded health plans, the
popularity of flexible-funded plans grow. Furthermore; improved
technology in automated claim processing and analysis has also inspired
wider utilization of flexible-funded plans. Complex claim and
benefit plan analysis capabilities previously reserved only for the
largest insurance companies are readily available to Third Party
Administrators (TPA’s). Third Party Administrators manage health benefit
plans just like traditional insurance companies, with few other
distinctions.
A TPA represents the interests of their client by actively
collaborating in the effort of keeping health expenditures under
control. HMA Administrators facilitates many of the newest state of the
art cost control technologies available in the industry today in an
effort to enhance the best possible experience and maximize savings.
In addition, the plans being offered include individual medical
questionnaires to be completed by all enrolling employees. This
information, not usually available to underwriters of most health plans,
enables the HMA Direct Underwriting and Actuarial Department to more
accurately predict the expected claims costs to be incurred during the
plan year. This avoids overcharging for claims funds and stop loss
premiums due to inaccurate assessments of claims costs.
HMA Direct is dedicated to representing and administering
flexible-funded health plans for its clients. Our commitment is
demonstrated by investing in staff education, cutting edge technological
advantages, and wellness programs, etc. which in return pay dividends to
our Doctors Choice Health Plan customers. Our programs are
designed to keep pace with all of the latest trends in the healthcare
industry today. HMA Direct is an industry leader that has
demonstrated the expertise necessary to effectively introduce new health
products such as; Health Savings Accounts (HSA’s), Health Reimbursement
Accounts (HRA’s), Flexible Spending Accounts (FSA’s), and Voluntary
Benefits, etc. for our clients.
When it comes to the effort involved in changing health plans, HMA
Direct is enthusiastic about assisting each employee with all of the
details associated with selecting the best coverage for their needs.
From the client's point-of-view, the change will be no more burdensome
that an annual renewal. All forms that are to be completed are
available on the internet for on-line editing and electronic signature
(where permitted), or available to be printed, hand written, signed and
mailed/faxed. The value of changing health plans is shared by each
employee as well as the company. The intention and result of the
HMA Doctors Choice Health Plan is to offer more control and flexibility
for the member, and to deliver significant cost savings.
|