Know Your ScoreUp-front assessment of group’s

health risk.

Review employee health history to evaluate risk.

Level Funding is for healthy groups of 5-150 employees.

Follow the Money Self-insured plan with a fixed monthly budget

- similar to a fully-insured plan.

Pay one fixed monthly payment that includes: Administration: plan operation and broker

services, Claim Funding: money for members claims, and

Stop Loss: insurance covers high claims beyond the monthly budget.

Change the Game with a Level Funding

Health Plan

Prevent SurprisesIf claims exceed claim fund, stop loss

insurance advances the di�erence.

Once claims are settled for the plan year TCC returns surplus to the employer -

and stop loss covers any deficit.

Most years most groups see a surplus.

Enjoy Your Own Private PoolFully-insured claims are “pooled” with

other groups.

Level-funded groups pay for their own claims,not the “community pool”.

Health management services help members improve their health and slow your health care spend.

Administration of self-funded, level funded,fully-insured, limited benefits, temporaryhealth and supplemental gap plans.

Utilization review and large case management services to optimize care at an appropriate cost.

Monthly reports help you understand how your plan is running and aid in designing the best benefits for your group.

Wellness and population health managementfocus our expertise on the 20% of yourmembers who generate 80% of your claims.

Pharmacy benefit management through cost e�ective PBMs including savings on expensive specialty drugs.

TCC Benefits Administrator is a full service third party administratorlocated in Charleston, South Carolina.Since 1972 TCC has earned a reputation for self-funding expertise, leading edge technology, and legendary customer care. Many of our clients have been utilizing TCC services for decades.

Many of our sta� have been with us for decadesas well. You’ll find our associates knowledgeable, e�cient and charming. Yes, charming. This is Charleston after all. TCC is small enough that you’ll know your contacts by name, yet part of a large, A+ (superior) health insurance group, providing enormous resources.

We put it all together with you and yourbroker. Consider all that TCC canprovide:

Network access for members to choose from for the best medical providers and realize in-network savings.

Out-of-Network savings through secondary, tertiary networks, as well as direct provider fee negotiation.

Delivering Creative Benefit Solutions for Business

ACA 6055 and 6056 employer datareporting requirements services.

Stop loss coverage from our preferred carriers protects your claim fund againsthigher than expected claim payments.

TCC systems are cutting edge from companies such as Trizetto, Hillary Software, RedCard and Deerwalk.

Management team of four with combined130+ years of experience in health benefitsfor groups and individuals.

Maximize the value of your benefits and minimize your costs. Let’s talk today!

Value added options like HRAs, FSAs,ancillary benefits and voluntary employee benefit programs.

Optional cloud-based online portal foremployee self-service, administratorsuite, and customer service call center.

Delivering Creative Benefit Solutions for Business

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Plan # 1 2 3 4 5 6 7 8 9 10

Participating Deductible $1,500 $2,000 $2,000 $2,000 $2,500 $3,000 $3,000 $4,500 $5,000 $5,000

Providers Family Ded. $3,000 $4,000 $4,000 $4,000 $5,000 $6,000 $6,000 $9,000 $10,000 $10,000

Coinsurance 80% 100% 80% 70% 100% 100% 80% 70% 100% 80%

Out of Pocket $4,500 $4,000 $6,350 $6,350 $3,000 $3,000 $6,000 $6,350 $5,000 $6,500

Family OOP $9,000 $8,000 $12,700 $12,700 $6,000 $6,000 $12,000 $12,700 $10,000 $13,000

Non‐Participating Deductible $4,500 $6,000 $6,000 $6,000 $7,500 $9,000 $9,000 $13,500 $15,000 $15,000

Providers Family Ded. $9,000 $12,000 $12,000 $12,000 $15,000 $18,000 $18,000 $27,000 $30,000 $30,000

Coinsurance 60% 70% 60% 60% 70% 70% 60% 60% 70% 60%

Out of Pocket $13,500 $12,000 $19,050 $19,050 $9,000 $19,050 $18,000 $19,050 $19,050 $19,500

Family OOP $27,000 $24,000 $38,100 $38,100 $18,000 $38,100 $36,000 $38,100 $38,100 $39,000

Participating Primary Care $40 $35 $40 $35 $20 $40 $50

Providers Specialist $75 $50 $75 $60 $40 Deductible $75 Deductible Deductible $75

Copays Retail Clinic $40 $40 $40 $40 $40 and  $40 and  and  $50

Urgent Care $75 $75 $100 $100 $75 Coinsurance $75 CoinsuranceCoinsurance $100

ER $250 $250 $500 $500 $500 $500 $500

Pharmacy Generic $10 $10 $10 $10 $10 $15 $15

Preferred $30 $35 $40 $45 $35 Deductible $45 Deductible Deductible $50

Non‐Preferred $50 $55 $70 $90 $60 and  $85 and  and  $100

Specialty Rx subject to deductible 20% 20% 20% 20% 20% Coinsurance 20% CoinsuranceCoinsurance 20%

Mail Service 2.5x 2.5x 2.5x 2.5x 2.5x 2.5x 2.5x

Preventive services as required under the PPACA are covered at no out-of-pocket expense. Unless otherwise indicated, physician office copays includecharges for diagnostic tests, labs,imaging, pathology, radiology, supplies and injections associated with the physician office visit. Copays do not applyto the deductible. Copays apply to the Participating Providers Out of Pocket Maximum limits. Outpatient surgical, diagnostic, and therapeutic services,inpatient hospitalization, home health care, skilled nursing facilties, and durable medical equipment expenses are covered subject to deductible and coinsurance.

Precertification for non-emergency services is required, and penalties apply for non-engagement for imaging (PET, MRI, CT) $100, out-patient services $250, in-patient services $500.

All plans include Medical Advocate Program for cost-effective navigation through an episode of care, providing provider cost and quality information.All plans include Teladoc telemedicine services at no additional cost or copay. Teladoc is not insurance.All plans include US Preventive Medicine population health management program.

Phoenix PBM is the pharmacy benefit manager. Specialty Pharmacy benefits are subject to the plan deductible.

The Plan of Benefits document is the final determination of benefits. revised 11.06.2017

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