An Alternative to Obamacare for Businesses in Southeastern Missouri
Now that Healthcare Reform is here to stay, the unfortunate reality as a business is your healthcare premiums will continue to rise and your ability to control your healthcare spend will greatly suffer.
Good News! You do have an alternative to Obamacare in Southeastern Missouri. This alternative is Community Care Missouri (CCM). CCM is a healthcare benefits program this has a unique answer for the challenges that employers face in providing healthcare benefits under healthcare reform.
CCM has established direct contracting with providers in Southeastern Missouri to provide quality healthcare and competitive pricing, which means you dramatically save on your healthcare spend.
How can CCM provide savings to your company? CCM will save your company money based on the delivery of care and the funding of care.
The healthcare plan has been constructed as a Preferred Provider Organization (PPO) that includes a local network with enhanced benefits and a national network that provides PPO benefits outside of the local network service area. The healthcare plan is segmented into three (3) specific tiers of benefits:
- Tier 1 – Benefit schedule based on the utilization of specific services from the local network (Evolutions Healthcare Systems – PRIME Network) with zero cost to the member
- Tier 1 with Copay – Benefit schedule based on the utilization of the local network (Evolutions Healthcare Systems – PRIME Network)
- Tier 2 – Benefit schedule based on the utilization of PHCS Network outside of the PRIME Network service area
- Tier 3 – Benefit schedule based on utilization of Non-Network providers
Highlights of Tier 1 Benefits
- $0 Copayment and 100% coverage for specific services provided by specific healthcare providers within the Tier 1 network
- Annual Deductibles and Coinsurance Maximums reduced to 50% of the Annual Deductibles and Coinsurance Maximums listed in Tier 2 of your benefit schedule when specific providers are utilized in the Tier 1 Network such as
- Black River Medical Center
- Saint Francis Hospital
- Healthcare Providers designated as Tier 1 with Copayments
- $0 Copayment for generic drugs when dispensed at specific pharmacies within the Tier 1 service area
CCM provides the advantages of a self-funded plan with the budget certainty advantages of being fully insured. CCM operates off a Level Funded chassis which is insured by A and A+ insurance companies. With CCM's Level Funding Plan and the smart use of Stop Loss Insurance, your company pays a monthly cost that is the maximum cost. No matter how many claims in a month, you will never pay more than this monthly cost. After all claims are paid for the year, the unused money in the claim fund is returned to your business, not 25%, 50% or 75% of the surplus - 100%!
Key features of the Level Funding Plan:
- Defined and Contained Risk - The employer's maximum exposure and annual costs are determined up front through the purchase of Stop Loss Insurance. Standard provisions include coverage for claims paid after the end of the plan year.
- Stabilized Cash Flow - Maximum annual claim liability is equally spread over 12 months. If the employer's claim fund does not contain sufficient money to cover claims, the reinsurance coverage will advance the necessary funds. The employer will not be requested to provide additional funding in excess of the monthly billed administration fees, reinsurance premium and maximum claims liability.
- Claim Fund - After the claim run-out period remaining funds are released or rolled over to the next year as credit. This is the essence of alternative funding - money not spent on benefits remains with the employer's benefit plan, not the insurance company.
- Plan Flexibility - Freedom to design a healthcare plan that has the ability to incorporate true healthcare risk management programs.
- Plan Performance - Every employer will have the ability to have access to plan information that will allow them to better manage and make healthcare plan decisions on a proactive basis instead of reactive.
- ERISA Plan - Exempt from some of the Affordable Care Act (ACA) regulations particularly those parts that may cause fully insured premiums to climb substantially in 2015 and beyond.
Bottom line: The plan design will encourage your employees to seek the proper and necessary care with providers within the CCM network, which will allow your company to realize true savings to your healthcare spend through the utilization of partially self-funded stop loss insurance.