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+ 10-12% Reserve . Factor. 130% Aggregate Protection + $10,000/certificate. + Trend Factors of 15- 22 EHC/Drugs, & 9 -13% Dental . (family) of large claims pooling (i.e. Stop Loss). + $10k per individual. + 10-13% Admin. Fees. of large claim pooling . + 20-25% Admin. Fee . - PowerPoint PPT Presentation
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Attract | Reward | Prosper
Traditional Plan (Fully Insured/Retention)
= MOST COSTLY way to fund your health, drugs & dental benefits
= LEAST COSTLY way to fund your health, drugs & dental benefits
Administrative Services Only (ASO)
Funding of your Program
Paid Health, Drugs and Dental ClaimsPaid Health, Drugs and Dental ClaimsPaid Health, Drugs and Dental Claims
130% Aggregate Protection + $10,000/certificate(family) of large
claims pooling (i.e. Stop Loss)
+ 10-13% Admin. Fees
Paid Health, Drugs and Dental ClaimsPaid Health, Drugs and Dental ClaimsPaid Health, Drugs and Dental Claims
+ $10k per individualof large claim pooling
+ 20-25% Admin. Fee
+ Trend Factors of 15- 22 EHC/Drugs, & 9 -13% Dental
+ 10-12% Reserve Factor
(e.g. 100 plan member group)
Attract | Reward | Prosper
How Does HealthProtectorPlus protect your company from individual/family catastrophic claimers?
$0
$5,000
$10,000
$15,000
$20,000
$25,000
$30,000
fam1 fam2 fam3 fam4
The Insurer Pays claims above $10,000 per year
per family
$10,000 Stop Loss Limit Applied
The Employer Pays claims under the $10,000 Stop Loss Limit per year
per family
Stop Loss Contract – Layer #1Per Certificate Catastrophic Protection
Attract | Reward | Prosper
Stop Loss Contract – Layer #2Group Catastrophic Protection
$0
$50,000
$100,000
$150,000
$200,000
$250,000
Last Years Claims This Years Claims
The Insurer covers catastrophic amounts
over 130% of last years trended claims
Employer covers up to a max. limit
of 130% of last years trended
claims
How Does HealthProtectorPlus protect your company from group catastrophic claimers?
Attract | Reward | Prosper
Transaction & Administration CostsHow you Administer Your Program
• Through an Insurance Carrier.
• Contract directly with the claims payor and each insurer separately.
• Through a Third Party Administrator (consolidation of multiple providers into one seamless program).
Which is the BEST way to administer your Benefits Program? …
Attract | Reward | Prosper
Insurer 1Life
Insurer 2AD&D
Insurer 3Disability
Insurer 4EHC/Dental Wellness
Third Party Administration (TPA)Insurance Administration for Employers
Online EnrollmentEmployer
HealthSource enrolls with various partners/insurers
