shopping for stop-loss coverage - healthlink · management; tami fenstermacher, technical writer,...
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winter 2015
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NEED TO KNOW NEWSPAGE 3
HEALTHLINK SPOTLIGHTPAGE 3
PRODUCTS AND SERVICESPAGE 2
ProviderInfoSource - Administrative Simplification for Health Plan Administrators ProviderInfoSource is a private, restricted portal utilized by providers to obtain real-time eligibility verification and online claim status which can alleviate costs associated with health plan administration. Contact your HealthLink representative for more information on getting set up on ProviderInfoSource.
Pre-Cert List Update Effective Jan. 1, 2016HealthLink has updated the list of procedures and services subject to medical necessity review for 2016. The additional service includes:
• Private Duty Nursing
For more information please contact [email protected].
Shopping for Stop-Loss CoverageHow self-funded employers can receive better rates for reinsurance coverage
As employers continue to search for alternative funding solutions to combat the high cost of health care, more companies now offer stop-loss or reinsurance coverage. This has created a unique environment for those shopping for stop-loss policies and may present an opportunity for employers and brokers to negotiate lower fixed rates for reinsurance coverage.
According to Mark Haegele, Regional Vice President of Sales at HealthLink, “Not all employers and brokers realize how much room for negotiation is available when shopping for stop-loss coverage.”
How can employers and brokers negotiate with stop-loss carriers?The main components of a self-funded model are the third-party administrator (TPA) that pays claims; pharmacy benefit manager (PBM), a network, such as HealthLink that contracts with doctors and hospitals for discounts; and the reinsurance carrier. However, it’s important to remember that in the eyes of the reinsurance carriers, there is no perfect model of self-funding components. This may open the door for the employer and broker to play a vital role in controlling the premium and overall stop-loss
cost. If you can validate the effectiveness of your vendor alignment – your TPA, network and PBM – you may be able to negotiate a decrease in premium.
In order to be successful at this, you must first demonstrate, in a refined and focused way, how you are working to manage and even lower the impact of large claims and why your specific arrangement warrants a discount.
How can you demonstrate your management of large claims?There are a number of strategies for controlling large claim costs. One example would be to add a dialysis or transplant carve out in your plan design. In this instance, you will pay a small premium for a transplant insurance policy and in-turn the reinsurance carrier gives you a credit.
Another option is working directly with your PBM. For a typical reinsurance carrier, more than 25% of all large claims are represented by prescription drugs. Finding a PBM that may be willing to further negotiate costs could reduce that expense and earn you a discount on your premium.
continued on page 3
Complete Your Benefits Package with Specialty ProductsOffering an entire spectrum of Specialty Products to fill in the gaps in an existing health plan is important for your employees. Together our affiliated companies cover more than 35 million people nationwide and deliver an outstanding comprehensive specialty portfolio. These Specialty Products are a great addition to a current HealthLink customer’s network program or as a standalone option for non-HealthLink clients:
DentalDental’s unique and comprehensive three network options offer employers choices not found in any other dental plan by offering three price points and distinctive, quality service from more than 500 dentists and specialists.
Life and DisabilityFeaturing a variety of options to choose from, outstanding claim service and a focus on returning employees to work, A Life and Disability program is the perfect way to complete an existing health plan. Additional features give members counseling and consultation services during times of need and offers support while traveling.
UniView VisionWith access to the largest national vision network that includes more than 44,000 independent provider and marquee retailer locations and the longest customer service
hours in the industry, UniView Vision members can
receive additional discounts over plan allowances from in-network providers after benefits are utilized.
Employee Assistance Program (EAP)Several plan designs to fit employer needs and budget with a robust EAP provider
network including access to a work-life resource network across the country.
To learn more about the complete Specialty Products portfolio, please contact HealthLink’s Sales Department at 800-235-0306.
Network arrangement adds more than 300 hospitals and 16,000 health care professionals to service area
HealthLink’s network arrangement with Midlands Choice, a regional preferred provider organization, enables employers to keep their health plans flexible and responsive to their employees’ needs by expanding HealthLink’s core service area to include Northern Illinois, Iowa, Nebraska, and South Dakota. Now employers with multi-sited locations, and members who need health care outside of the HealthLink service area, have the ability to better manage overall health care costs while also
providing members with a better health care experience. To learn more, please contact HealthLink’s Sales Department at 800-235-0306
HealthLink and Midlands Choice Expand Network Access for Clients
Iowa
South Dakota
Nebraska
Missouri
Illinois
Adair
Adair
Adams
Adams
Adams
Alexander
Allamakee
Andrew
Antelope
Appanoose
Arthur
Atchison
Audrain
Audubon
Aurora
Banner
Barry
Barton
Bates
Beadle
Bennett
Benton
Benton
Black Hawk
Blaine
Bollinger
Bon Homme
Bond
Boone
Boone
Boone
Boone
Box Butte
BoydBremer
Brookings
Brown
Brown
Brown
Brule
Buchanan
Buchanan
Buena Vista
Buffalo
Buffalo
Bureau
Burt
Butler
Butler
Butler
Butte
Caldwell
Calhoun
Calhoun
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Camden
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Carroll
CarrollCarroll
Carter
Cass
Cass
Cass
Cass
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Cedar
Cedar
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Charles Mix
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Cherry
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Christian
Christian
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Douglas
Douglas
Douglas
Douglas
DuPage
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Dundy
Dunklin
Edgar
Edmunds
Edwards
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EmmetFall River
Faulk
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Fayette
Fillmore
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Franklin
Franklin
Franklin
Franklin
Fremont
Frontier Fulton
Gage
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Grant
Grant
Greeley
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Greene
Gregory
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Grundy
Grundy
Guthrie
Haakon
Hall
Hamilton
Hamilton
Hamilton
Hamlin
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Hancock
Hand
Hanson
Hardin
Hardin
Harding
HarlanHarrison
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Henry
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Hitchcock Holt
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Johnson
Johnson
Johnson
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Jones
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Lee
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Lincoln
Lincoln
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Livingston
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Logan
Louisa
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Lucas
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Lyon
Macon Macon
Macoupin
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Madison
Madison
Madison Mahaska
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Marion
Marion
Marion
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Marshall
Marshall
Mason
Massac
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McDonald
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McLean
McPherson
McPherson
Meade
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Menard
Mercer
Mercer
Merrick
Miller
Mills
Miner
Minnehaha
Mississippi
Mitchell
Moniteau
Monona
Monroe
Monroe
Monroe
Montgomery
Montgomery
Montgomery
Moody
Morgan
Morgan
Morrill
Moultrie
Muscatine
Nance
Nemaha
New Madrid
Newton
Nodaway
Nuckolls
O'Brien
Ogle
Oregon
Osage
Osceola
Otoe
Ozark
Page
Palo Alto
Pawnee
Pemiscot
Pennington
Peoria
Perkins
Perkins
Perry
Perry
Pettis
Phelps
Phelps
Piatt
Pierce
Pike
Pike
Platte
Platte
PlymouthPocahontas
Polk
Polk
Polk
Pope
Pottawattamie
Potter
Poweshiek
Pulaski
Pulaski
Putnam
Putnam
Ralls
Randolph
RandolphRay
Red Willow
Reynolds
Richardson
Richland
Ringgold
Ripley
Roberts
Rock
Rock Island
Sac
Saline
Saline
Saline
Sanborn
Sangamon
SarpySaunders
Schuyler
SchuylerScotland
Scott
Scott
Scott
Scotts Bluff
Seward
Shannon
ShannonShannon
Shelby
Shelby
Shelby
Sheridan
Sherman
Sioux
SiouxSioux
Spink
St. Charles
St. Clair
St. Clair
St. Francois
St. Louis CitySt. Louis County
Stanley
Stanton
Stark
Ste Genevieve
Stephenson
Stoddard
Stone
Story
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Sully
Tama
Taney
Taylor
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Thomas
Thurston
Todd
Tripp Turner
Union
Union
Union
Valley
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Warren
Warren
Washington
Washington
Washington
Washington
Wayne
Wayne
Wayne
Wayne
Webster
Webster
Webster
Wheeler
White
Whiteside
Will
Williamson
Winnebago
WinnebagoWinneshiek
Woodbury
Woodford
Worth
Worth
Wright
Wright
Yankton
York
Ziebach
SM
Midlands Choice Service Area
HealthLink Service Area
winter 2015
HealthLink associates rolled up their sleeves and volunteered their time for two events held during Volunteer Days, a company-wide month of service in October. At the first event, held on October 3rd, associates joined the local fire department at Fire Safety Day at the Delta Gamma Center for Children with Visual Impairments. Associates joined the children in a fire drill, exploration of the fire truck and ambulance and participated in obstacle courses. On October 16th, associates joined the local Lions Club to pack weekend food bags at the Rap and Pack event, a part of Operation Food Search, where a total of 1,800 bags of food were packed for 33 schools in 11 districts in under an hour.
This was the inaugural year for the annual Volunteer Days program. Each event was very successful and enjoyed by all in attendance.
As of October 1, 2015, HealthLink is LIVE with ICD-10 as the code set for medical diagnoses and inpatient hospital procedures in compliance with HIPAA requirements and in accordance with the rule issued by the U.S. Department of Health and Human Services (HHS).
How did HealthLink prepare for ICD 10?Associates worked hard to ensure there were no business distruptions by configuring all Electronic Data Interchange (EDI) outbound transmissions to payors (including insurance carriers, TPAs and self-insured employers) to accommodate ICD-10 codes.
HealthLink Associates Roll Up Their Sleeves During Company-Wide Month of Service
ICD-10 Now LiveBoth of these practices will not only help you reduce the cost of your stop-loss premium, but can also help you control your overall claims in the long run. HealthLink also has a variety of cost containment solutions and reporting capabilities that may help you better manage your claims.
How should employers and brokers examine stop-loss carriers to find the best price?The most important fact to keep in mind is that reinsurance carriers place a “rating” on networks and give them different levels of credibility with respect to their discounts. This means carriers determine their own version of your network’s discount by applying their creditability percentage to it.
The good news is selecting a stop-loss carrier that already has a good relationship with your network could lower your premium. HealthLink has worked hard to establish strong relationships with stop-loss carriers and ensure our network has a high creditability rating and our clients can receive the highest premium discounts available. Contact your HealthLink representative for a full list of stop-loss carriers and for more information about how you may be able to lower your premiums.
Shopping for Stop-Loss continued from page 1
Volunteers at Rap and Pack event.
Participating in Fire Safety Day.
HealthLink®, Inc., is an Illinois corporation. HealthLink, Inc. is an organizer of independently contracted provider networks, which it makes available by contract to a variety of payors of health benefits. HealthLink has no control or right of control over the professional, medical judgment of contracted providers, and is not liable for any acts or failures to act, by contracted providers. HealthLink, Inc. is not an insurance company and has no liability for benefits under benefit plans offered or administered by payors. HealthLink® is a registered trademark of HealthLink, Inc.
Our goal in creating Network News is to inform clients of pertinent information helpful to your business relationship with HealthLink. We welcome your ongoing feedback.
Editorial Board: Steve Martenet, HealthLink President; Brian Fallon, Director of Payor Relations, Business Development and Network Management; Tami Fenstermacher, Technical Writer, Payor Relations; Susan French, Director, Marketing/Communications; Alicia Pyatt, Marketing Communications Writer; Jeff Wulfert, Senior Designer. Comments or suggestions: (800) 624-2356.
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Provider Updates PRSRT STD
US POSTAGEPAID
SAINT LOUIS, MOPERMIT NO. 1514
New PPO, Open Access (HMO) and Workers’ Compensation Contracts • Freeman Surgery Center of Pittsburg, LLC, Pittsburg, KS
(added to the Freeman Hospital agreement). Effective October 1, 2015.
• Frontenac Surgery and Spine Care Center, St. Louis, MO. Effective October 15, 2015.
• Marion Healthcare (ambulatory surgery center), Marion, IL. Effective October 1, 2015.
• SEPM Missouri Services, PC (ER group servicing multiple BJC facilities), St. Louis, MO. Effective November 15, 2015.
• SE Emergency Physicians of Memphis, PC (ER group servicing Boone Hospital), Columbia, MO. Effective November 15, 2015. FOLLOW US ON:
linkedin.com/company/healthlink-inc-