You Just Sold a Level Fund Health Plan and saved your client and their employees thousands of dollars on their health insurance. YOU are a HERO….this year.
As a health insurance broker, you discussed with your client the advantages and disadvantages of a level fund plan as compared to a fully-funded, ACA compliant health insurance plan, discussed the details of the covered benefits, explained the provider networks included, amount of deductibles, co-pays, coinsurance, the possibility of a refund…….and, of course, the individual and aggregate stop-loss limits. All is good and the client is incredibly happy.
Keeping your fingers crossed and the cost of claims for the plan year remain under stop-loss limits, the client enjoys a refund and you sign them up for another year. Excellent!
But what happens if claims exceed stop-loss limits?
Perhaps you were monitoring the periodic claims report and saw the costs piling up. You try to get out ahead of the bad news and inform the client they’re having a ‘bad year’ in healthcare costs. But what can you really do? Manage expectations by informing them if claims blow past their stop-loss limit they will likely have to go back to a fully funded medical plan and back to higher healthcare premiums. The client will not be happy and will probably ask additional brokers to provide health plan quotes for the next plan year.
As a health insurance broker, is there anything you could have done differently? This is part of the risk of a level fund plan, right?
The challenge with level fund (and self-funded) health plans is claims cost containment. This is certainly not a secret. There have been many strategies attempted to address this issue – wellness programs, provider advocacy services, telemedicine offerings, and more. Unfortunately, utilization has been low, and results lacking with these attempts.
ModRN Health provides a proactive approach working directly with employees, providing coaching, education, and options for informed decision making. The ModRN Health registered nurse assigned to each employee becomes their go-to person for anything healthcare-related. Not only does the RN provide care for their health but also navigates the complexity of the healthcare system to find the best value of services with the highest outcomes – shopping for healthcare services. Additionally, the ModRN Health nurse does not wait for the employee to reach out but proactively and routinely contacts employees to check in with them.
For complex and chronic conditions, the ModRN Health RN is heavily involved in the employee’s care planning, monitors to ensure protocols and treatment are clearly understood, creates scheduled check-points for status and results, and provides on-going guidance and support.
Yes, there is something you can do for your level-funded clients. Provide a ‘front-end’ with ModRN Health. You will greatly increase your client’s chance for a refund and your chance for renewal.