Ecom Owners Group health Insurance
GROUP RATE HEALTH INSURANCE JUST FOR ECOMMERCE ASSOCIATION MEMBERS
Is your business looking for Group Health Insurance?
GET TO KNOW THE LIFESTYLE HEALTH BENEFITS PROGRAM
This program provides the members of the Ecom Insurance Association with a comprehensive health insurance program designed to strategically manage healthcare costs while still providing employees great benefits in all states! By offering affordable coverage along with proactive cost containment and employee wellness features, companies can strategically manage their healthcare costs while still maximizing benefits for their employees.
Your company will enjoy:
A: By choosing from multiple national and regionally based PPO networks, we try to match up the providers as well as possible. As with any change in carriers, some providers aren’t in every network. We thoroughly examine the networks that are available during the decision-making process.
A: The Lifestyle Health Program offers 16 different plan designs that your group may select from. Depending on the group size, up to 4 plans can be offered to the employees to choose from. While there will be some differences between the LHP plans and your current plan, we should be able to improve the benefits to the employees by offering a deductible credit through the Wellness Program as well as some other value-added benefits (Care Coordination, Lab Benefit, Diabetic Supplies, Telemedicine, Rx Benefits, etc.).
A: The only start-up cost is your first monthly premium payment.
A: Lifestyle Health Plans is an innovative, boutique health benefits program and has been offered throughout the country since 2006 in partnership with a host of A-rated reinsurance carrier partners. Since Lifestyle relies on PPO networks for discounts and re-pricing, it is important to use a doctor in the network selected (just like your current plan). On your Member ID Card, you will find a logo for your plan’s PPO Network. Your provider will recognize the PPO Network even if they have not yet had extensive experience with Lifestyle.
A: NO. All run out costs are accounted for within the monthly premiums.
A: A census is provided to the Third Party Administrator (TPA), who determines a monthly cost comprised of three elements, each roughly representing one-third of the monthly payment: a claims allowance, a TPA fee, and a premium for stop-loss coverage. This consistent, or level, amount is funded by the company each month. The claims allowance goes into an account from which employee medical costs are funded. The TPA fee goes towards paying for the administration of the program, including adjudicating claims. And the stop-loss premium goes towards that coverage. As claims come in on a monthly basis, the TPA pays them out of the claims allowance. If there is an extraordinary claim on an individual or aggregate basis, the stop-loss kicks in. In no case does the employer have to pay more than the level amount.
A: At the end of the year, the performance of the group is evaluated. If the group has performed well, some of that claim allowance may be returned to the group. And the group may beneﬁt from a lower “rate” for the next year on the basis that the monthly allowance should be less, as should the premium for the stop loss. If the group performs as originally expected, there should be little or no increase — a rarity in the ACA world. But what if the group has a really bad year? In a bad year, the stop-loss kicks in to protect the employer. Again, the entire concept of the level-funded plan is that the employer never has to pay more than the level monthly amount. But as an underwritten plan, it is reasonable to expect an increase — perhaps even an untenable increase — in the level-funded plan. Here is where it really gets interesting. Today, in such a situation, the group can simply revert back to a community-rated ACA plan. Here, small groups have an advantage that large groups do not: they can revert back to a non-underwritten plan; one that is likely to be to their ﬁnancial beneﬁt.