november 2017 alternative funding: follow the money 2017 alternative funding: follow the money. ......
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Confidential
Presented by:
Elizabeth Patterson, Managing Consultant
November 2017
Alternative Funding:
Follow the Money
Agenda
• Funding… What’s Changed?
• Plan Expenses
• Fixed Costs
• Claim Costs
• Trend
• High Claimants
• Alternative Funding Spectrum
• Cash Flow
• Carrier Models
• Risk Management
1
Funding… What’s Changed?
• Increasing Costs
• Willingness to assume risk for potential savings
• Desire to control what has historically been uncontrollable
• Appetite to manage cash flow and budget process
• Demand to take advantage of plan and cultural changes that lower trend
• Taxes
• State taxes (2.5%)
• ACA taxes (5%)
• Demographic rating and essential benefits under 100 employees
• Regression to the mean
• Inability to escape a trend increase
• Increased variety of risk sharing options to meet diverse
employer risk profiles
2
Plan Expenses
No matter what funding or risk mechanism you use,
Total Annual Cost of Your Medical Plan
Less High Claimants
Plus Expected Claims
Fixed Costs
3
Fixed Costs
4
Potential Taxes2.5% - 6.5%
Commisions4.0%
Risk Charge3.0%
Operating Expenses 9.5%
Profit 1.0%
Defining Operating Expenses
Cost of Doing Business:
• Salaries
• Electricity
• Network development
• Report preparation
• Customer service
• Wellness programs
• Rent
• Technology
• Claim processing
• Eligibility maintenance
• Disease management
• Taxes, etc.
5
Nothing is “free” – it is in the rates!
Claim Costs
6
Expected Claims
Pooling Charge
High Claimants
Incurred but Not
Revealed (Reserve)
Network Discounts
and Utilization
Mix
Expected Claims
When a medical plan is experience rated, the general underwriting
rule of thumb is:
The most recent 12 months of
mature claim data
Trend
The best predictor of
the new plan year’s claims
7
Defining Claims
Paid claims are the actual dollars paid to doctors, hospitals,
pharmacies and other providers during the time period under study
“Paid claims” does not include:
• What the employee pays for care
• Denied claims
• Network discount adjustment
Incurred but not revealed (IBNR)
• Services that occurred during the period under study for which no claim has
been submitted
• High claimant can skew reserve levels because it takes longer for a large
hospital claim to be submitted
8
IBNR – Why Is There a Claim Lag?
15 – 45
Days
Doctor
Visit
PaymentClaim
Approved
Claim
Submitted
9
Defining Trend
Insurance companies use medical cost trends to estimate what
the same plan would cost in the next year
In the simplest example, a plan with the same members that cost
$8,000 last year with 10% trend will cost $8,800 next year
• Trend is typically discussed as an annual number
• When your renewal is determined, claims are moved more than 12 months into the future, so the actual trend used is higher
• The earlier your renewal is delivered, the more trend impacts the final numbers
10
Defining Claims – High Claimants
• High claim activity is not predictable from year to year until the group of covered
persons becomes quite large – typically over 5,000 employees
• The premium rate includes a “pooling charge” and self-funding includes “specific
reinsurance”
• In return for this charge, the insurance company ignores claims for any one person that
are higher than your “pooling point”
$1.2 million pooled to
pay for high claimants
$300,000
$275,000
$400,000
$150,000
$75,000
Pooling Charges (or specific
reinsurance premium)
create a pool of money that
the insurance company
uses to pay for claims over
the pooling point.
In this example, the pooling
charge from five employers
create a pool of $1.2 million
to pay for that group’s high
claimants.
11
Incurred claims for the last 12
months
Plus IBNR calculation
Less claim amounts
greater than the
individual pooling point
Multiplied by trend
Plus the pooling charge
Developing Expected Claims
12
Why Assume Additional Risk
13
Employers typically
want more risk if
Group is young & healthy
Insurance companies are over-charging
Accessibility of detailed claims data
Positiveimpact to cash flow
Control of own destiny
Simplify plan design -
Fewer state laws
Achieve cost transparency
Spectrum of Rating Methods
14
Potential savings
Potential annual risk
Small Group Rated and Demographic Rated
Experience Rated: Not Credible, Credible and Participating Policies
Level Funded, Minimum Premium and Retrospective Funded
Self-Funding via a Captive/Consortium
Traditional Self-Funding
Follow the Money – How Costs Flow
15
• Claims are lower than the monthly average in the first 3 months and continue after the plan year ends
• Run-out claims can occur as much as 12 months after the plan year ends, but 90%+ are expected in the
first 3 months
• Fixed costs can all be paid in the first 12 months to cover all claims incurred in that plan year or can be
paid to just cover the activity that occurs in the first 12 months
• 12 month costs are called “immature” An estimate the covers all the activity of the first 12 months is called
“mature”
• A high claimant who incurred $700,000 in claims hit in August and September. Amounts above the
individual stop loss are either paid by employer and reimbursed or paid by carrier and not used at next
renewal
Admnistrative and High
Claimant Fees Cover
Run Out
January
xxx1
February
xxx1
March
xxx1
April
xxx1
May
xxx1
June
xxx1
July
xxx1
August
xxx1
September
xxx1
October
xxx1
November
xxx1
December
xxx1
January
xxx2
February
xxx2
March
xxx2
Administrative Costs $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414
High Claimant Protection $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988
Claims $52,000 $167,521 $324,230 $292,568 $171,087 $343,880 $218,196 $535,000 $455,000 $266,376 $313,921 $371,204 $176,925 $98,623 $27,956
Admnistrative and High
Claimant Fees Do Not
Cover Run Out
January
xxx1
February
xxx1
March
xxx1
April
xxx1
May
xxx1
June
xxx1
July
xxx1
August
xxx1
September
xxx1
October
xxx1
November
xxx1
December
xxx1
January
xxx2
February
xxx2
March
xxx2
Administrative Costs $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131
High Claimant Protection $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 TBD TBD TBD
Claims $52,000 $167,521 $324,230 $292,568 $171,087 $343,880 $218,196 $535,000 $455,000 $266,376 $313,921 $371,204 $176,925 $98,623 $27,956
Follow the Money – Cash Flow if Insured
16
• A fully insured client pays the same amount each month no matter what the claims are for that
month
• A small group client, under 100 employees, has rates based on each covered person’s age and
geography
• A group under 500 employees enrolled has rates that blend their claim experience with the claim
experience of other employers. This is done to stabilize rates because claims year to year can
fluctuate by plus or minus 20% in mid-size groups. This is called credibility
• Ideally over a 3 to 5 year period, credibility should have a neutral impact on costs. However, in any
given year, it can raise increase or decrease a renewal (vs what the renewal would have been on
that employers claims)
15 Month Flow of
Costs
January
xxx1
February
xxx1
March
xxx1
April
xxx1
May
xxx1
June
xxx1
July
xxx1
August
xxx1
September
xxx1
October
xxx1
November
xxx1
December
xxx1
January
xxx2
February
xxx2
March
xxx2
Administrative Costs $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131
High Claimant Protection $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 TBD TBD TBD
Claims $52,000 $167,521 $324,230 $292,568 $171,087 $343,880 $218,196 $535,000 $455,000 $266,376 $313,921 $371,204 $176,925 $98,623 $27,956
Insured 15 Month Flow
of Cash
January
xxx1
February
xxx1
March
xxx1
April
xxx1
May
xxx1
June
xxx1
July
xxx1
August
xxx1
September
xxx1
October
xxx1
November
xxx1
December
xxx1
January
xxx2
February
xxx2
March
xxx2
Premium $301,400 $301,400 $301,400 $301,400 $301,400 $301,400 $301,400 $301,400 $301,400 $301,400 $301,400 $301,400 $0 $0 $0
Follow the Money – Monthly Rate Risk Sharing
• Settlement is performed 3 to 6 months after the end of the liability period
• In the above example a portion of the premium will be refunded to the employer.
• If actual costs were above premium, some carriers forgive this deficit. Other carriers use it to
offset the refund in a future, good claims year
17
Admnistrative and High
Claimant Fees Cover
Run Out
January
xxx1
February
xxx1
March
xxx1
April
xxx1
May
xxx1
June
xxx1
July
xxx1
August
xxx1
September
xxx1
October
xxx1
November
xxx1
December
xxx1
January
xxx2
February
xxx2
March
xxx2
Administrative Costs $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414
High Claimant Protection $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988
Claims $52,000 $167,521 $324,230 $292,568 $171,087 $343,880 $218,196 $535,000 $455,000 $266,376 $313,921 $371,204 $176,925 $98,623 $27,956
Admnistrative and High
Claimant Fees Do Not
Cover Run Out
January
xxx1
February
xxx1
March
xxx1
April
xxx1
May
xxx1
June
xxx1
July
xxx1
August
xxx1
September
xxx1
October
xxx1
November
xxx1
December
xxx1
January
xxx2
February
xxx2
March
xxx2
Premium $310,442 $310,442 $310,442 $310,442 $310,442 $310,442 $310,442 $310,442 $310,442 $310,442 $310,442 $310,442 $0 $0 $0
Year End Settlement Premium is +3% higher than standard fully insured, but if claims are lower, money is returned
Fixed Costs
Paid Claims This arrangement can be fully insured and is called either participating or retrospective rated.
Total Paid
This arrangement can be self-funded and is called level funding
Paid Premium
Difference
$616,824
$2,976,000
$3,592,824
$3,725,304
$132,480
Aetna IBC Cigna
Product Funding Advantage Participating or
Retrospective
50% Dividend Eligible
Employer Size 100 – 500 employees 250 + employees 250 – 500 employees
Billing Pay fixed monthly rate
set at +10% of expected
claims
Pay fixed monthly rate
set at +3% to +7% of
expected claims
Pay fixed monthly rate
often set at expected
Margin/Deficit Aetna retains 1/3 of
surplus at end of year;
Client retains 2/3 of
surplus to carry over as
credit to next year (New
business is 50/50 split)
Margin/deficit at year end
settlement. Percentage
returned to client based
on risk corridor
At end of year, 50% of
surplus is returned to
client
Examples
18
Follow the Money – Monthly Rate Risk Sharing
Be sure to understand if your plan is rated on a mature or an
immature basis
19
Admnistrative and High
Claimant Fees Cover
Run Out
January
xxx1
February
xxx1
March
xxx1
April
xxx1
May
xxx1
June
xxx1
July
xxx1
August
xxx1
September
xxx1
October
xxx1
November
xxx1
December
xxx1
January
xxx2
February
xxx2
March
xxx2
Administrative Costs $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414
High Claimant Protection $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988
Claims $52,000 $167,521 $324,230 $292,568 $171,087 $343,880 $218,196 $535,000 $455,000 $266,376 $313,921 $371,204 $176,925 $98,623 $27,956
Admnistrative and High
Claimant Fees Do Not
Cover Run Out
January
xxx1
February
xxx1
March
xxx1
April
xxx1
May
xxx1
June
xxx1
July
xxx1
August
xxx1
September
xxx1
October
xxx1
November
xxx1
December
xxx1
January
xxx2
February
xxx2
March
xxx2
Premium $248,533 $248,533 $248,533 $248,533 $248,533 $248,533 $248,533 $248,533 $248,533 $248,533 $248,533 $248,533 $323,093 $323,093 $323,093
Year End Settlement
Fixed Costs Rates are set at 80% of expected costs because they only account for 12 months of expense activity.
Paid Claims
Total Paid
Paid Premium
Difference The second year settlement includes claims incurred in year 1, but paid in year 2. Year 3 is a normal renewal.
$616,824
$2,380,800
$2,997,624
$2,982,396
$15,228
The simple renewal estimate is that rates increase by 20% to cover 12 months of expenses and 15 months of activity. In
addition, 10% trend is applied. This means if claims run as expected in year 1, the renewal is +30%.
Pay As You Go – Minimum Premium /Self Funded
• In August and September claims of $700,000 are paid on one individual. If you assume a $200,000 pooling
point, then $500,000 will be refunded to the employer
• In some models, the employer never pays the $500,000 - the reinsurance carrier pays it. In other models it can
take 5 business days to over 5 months to recoup this money
• The employer needs to understand whether estimated annual costs are based on 12 months or 15 months of
activity (Immature or mature) in order to anticipate the next year's renewal
• Many employers take a cash flow advantage in the first year of self-funding by paying for 12 months of activity in
the fixed costs during the first year, knowing:
• They must pay for extra months of claims administration and reinsurance protections when they terminate
either the financial arrangement or the current claims administrator
• They must be prepared for a large increase in year two
• Minimum Premium plans typically require a reserve that covers 15 months of activity, so no cash flow advantage
20
Admnistrative and High
Claimant Fees Cover
Run Out
January
xxx1
February
xxx1
March
xxx1
April
xxx1
May
xxx1
June
xxx1
July
xxx1
August
xxx1
September
xxx1
October
xxx1
November
xxx1
December
xxx1
January
xxx2
February
xxx2
March
xxx2
Administrative Costs $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414 $31,414
High Claimant Protection $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988 $19,988
Claims $52,000 $167,521 $324,230 $292,568 $171,087 $343,880 $218,196 $535,000 $455,000 $266,376 $313,921 $371,204 $176,925 $98,623 $27,956
Admnistrative and High
Claimant Fees Do Not
Cover Run Out
January
xxx1
February
xxx1
March
xxx1
April
xxx1
May
xxx1
June
xxx1
July
xxx1
August
xxx1
September
xxx1
October
xxx1
November
xxx1
December
xxx1
January
xxx2
February
xxx2
March
xxx2
Administrative Costs $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131 $25,131
High Claimant Protection $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 $15,990 TBD TBD TBD
Claims $52,000 $167,521 $324,230 $292,568 $171,087 $343,880 $218,196 $535,000 $455,000 $266,376 $313,921 $371,204 $176,925 $98,623 $27,956
In – Summary Risk Sharing Favorable Year
21
In Summary - Risk Sharing Unfavorable Year
22
Alternative Funding – Cost Projections
23
Who pays if the estimate is low?
YOU DO!
Self-Funding – Cost Projections
24
Alternative Funding - False Promise
• Some first year alternative funding proposals are immature and do not include an
estimate for claim lag
• This means that the cost of a first year self-funded plan is understated by 10% to 20%
and allows a broker who is trying to obtain your business to pitch it as a guaranteed
first year savings
• They are correct. There will be first year savings, but these savings do not repeat, so
you have to be ready for year two
• Protect yourself by asking to see mature and immature first year costs
25
Alternative Funding - False Promise
Many brokers determine your expected costs using the “best” (most aggressive) reinsurance
proposal. This approach can lead you holding the bag on an understated budget
Let’s assume your true expected claims are $500 per employee per
month and you request maximum liability set at 125% of expected
26
NFP’s Claim Estimate
Reinsurance wants your business
Self-Funding – Cost Projections
• NFP’s Methodology
• We believe it is prudent to develop cost projections via an independent
process
• NFP uses multiple methods to determine your expected claims and your
case trend
• We will share our methodology with you
• NFP uses actuarial tools to compare your claims experience with
demographic norms
• NFP underwrites your plan separately from your TPA and/or reinsurance
provider
• We tell you, our client, if we think the reinsurance company has
understated or overstated your claims
• You make an informed decision and budget properly
27
Know Where Your Claims are Unpredictable
While year to year trend for claimants under $50,000 ranges
from -4% to +9%, average trend for claimants under $50,000
during the 6 years study period is only is +2%. Claims in this
range are relatively stable.
28
Protect Yourself – Understand the Nuances
29
Protect Yourself – Understand the Nuances
30
Interest
Charges
Fixed
Monthly
Cost
Fixed
Monthly Cost
with True Up
Year End
True Up
Understand the Nuances
• What are some cash flow models?
• Do I pay as claims are incurred?
• Do I pay a flat monthly rate with a true-up?
• How long does it take for a true-up to occur?
• What if my monthly claims are under budget?
• What if my monthly claims are over budget?
• Are projected costs immature or mature?
• Do I have to fund high claims and wait for a refund?
• Who holds the reserves? How are they developed? What if run-out claims
are above or below the reserves?
• What happens if I terminate in a deficit position?
• What is the corridor between expected and maximum costs?
• What is in place to stabilize my claims experience?
31
Reinsurance Considerations
• First year only looks at claims incurred in first 12 months
• Paid in those 12 months
• Paid in 15 months – those 12 and next 3
• Paid in 18 months – those 12 and next 6
• Second year can look at
• Claims incurred in that 12 months and paid in next 15 or 18
• Claims incurred in that 12 months and prior 3 or 6, but paid
in that 12 months
• Claims paid in that 12 months no matter when incurred
32
January
xxx1
February
xxx1
March
xxx1
April
xxx1
May
xxx1
June
xxx1
July
xxx1
August
xxx1
September
xxx1
October
xxx1
November
xxx1
December
xxx1
January
xxx2
February
xxx2
March
xxx2
Claims $52,000 $167,521 $324,230 $292,568 $171,087 $343,880 $218,196 $535,000 $455,000 $266,376 $313,921 $371,204 $176,925 $98,623 $27,956
Reinsurance Considerations
Reviewing a Lag Report can help you select the type of protection you need
33
Recorded Incurred Month
Month Dec-10 Nov-10 Oct-10 Sep-10 Aug-10 Jul-10 Jun-10 May-10 Apr-10 Mar-10 Feb-10 Jan-10
Dec-10 29,311 35,600 71,101 1,115 0 3,640 632 13,210 0 0 0 0
Nov-10 0 19,611 49,799 5,837 361 483 607 60 16 0 182 182
Oct-10 0 0 16,335 81,075 35,018 -100 -7,037 22 605 472 790 656
Sep-10 0 0 0 24,859 73,949 44,876 3,740 123 44,179 0 3,959 28
Aug-10 0 0 0 0 22,030 84,250 17,482 4,148 10,841 284 -204 0
Jul-10 0 0 0 0 0 25,626 110,004 48,267 1,835 -1,001 1,351 -121
Jun-10 0 0 0 0 0 0 31,998 105,534 6,825 1,119 1,648 271
May-10 0 0 0 0 0 0 0 30,575 79,086 17,442 1,684 5,700
Apr-10 0 0 0 0 0 0 0 0 27,434 57,089 3,176 1,416
Mar-10 0 0 0 0 0 0 0 0 0 39,149 86,943 78,809
Feb-10 0 0 0 0 0 0 0 0 0 0 16,527 68,932
Jan-10 0 0 0 0 0 0 0 0 0 0 0 0
Totals 29,311 55,211 137,235 112,886 131,358 158,775 157,426 201,939 170,821 114,554 116,056 155,873
Bottom Line - Running the Numbers
34
The Parts are the Same
35
Item Fully Insured Alternative Funding
Claims Claims Claims
Protection vs.
High ClaimantsPooling charge Specific reinsurance
Fee to Cover Claims
AdjudicationIn fixed costs Administration fee
Fee to Develop and
Maintain NetworkIn fixed costs
Network access/rental fee in claims
or administration fee
Protection vs.
Bad Year
In fixed costs
(Risk charge/margin)Aggregate reinsurance
Disease Management In fixed costsCan be purchased separately or “a la
carte” or in administration fee
Commissions In fixed costs In reinsurance and administration fee
Plan Expenses
36
• If the same claims payer, using the same
plan design, the same network discounts
and the same cost management programs
processed your claims, the only
guaranteed cost differences between
funding alternatives is state premium
and federal ACA taxes.
• Over time, typically a five year period, a
well negotiated fully insured plan should
cost a little bit more than an identical self-
funded plan. The difference being taxes.
• Your advisor should be able to provide you
a clear retrospective analysis of your plan
using your claims to help you understand
where you stand.
Plan Expenses
Over 4 year period, the cost of being fully insured is $505,078 or 1.8%. This equates to taxes.
Year 1 Year 2 Year 3 Year 4 4 Year Total
Current Insured Plan $6,142,970 $6,332,678 $6,997,284 $7,127,640 $26,600,572
Self-Funded Plan $6,121,883 $7,171,193 $6,274,420 $6,527,998 $26,095,494
$21,087 ($838,515) $722,864 $599,642 $505,078
37
Why Assume Additional Risk
38
Employers typically
want more risk if
Group is young & healthy
Insurance companies are over-charging
Accessibility of detailed claims data
Positiveimpact to cash flow
Control of own destiny
Simplify plan design -
Fewer state laws
Achieve cost transparency
Interesting Models
39
Reinsurance Captive
• First question is, “Do I want to
be self-funded”
• Second question is, “If yes,
should I share high claimant risk
with other employers to stabilize
fixed costs?”
• Goal:
• Reduce fixed costs by
purchasing a higher individual
stop-loss level than is practical of
purchasing alone
• Share the risk of middle cost
claimants with other employers
• Stabilize costs (rate of increase)
over time
40
Reinsurance Captive
• Captive Reinsurance – Group purchasing model
• Each employer is responsible for high claimants up to a defined amount – typically $35,000 to
$75,000
• Each employer pays a fixed monthly amount into a pool designed to fund claims between their
defined amount and the reinsurance
• Employers collectively purchase reinsurance for claimants over a high amount, often $250,000
• Risks and Rewards
• Some members in the group will have a good year, while others have a bad year rather than
each member’s reinsurance being rated on it’s own merits
• This approach allows for cost stability while not paying a large fixed premium to a reinsurance
company
• If the fixed cost for the monthly pool is too low, employers may be assessed additional,
unexpected payments
• Total costs are typically 1% to 3% higher than being self-funded alone due to administrative
costs of the captive
41
Follow the Money – Captive Reinsurance
42
Claims over $250,000
Claims $50,001 to $250,000
Claims under $50,000
Claims paid by reinsurance
company. You pay monthly
premium
Claims paid by you
Claims paid by captive
members. Each employer pays
a monthly allotment into the
pool. Any funds remaining at
year end are returned or rolled-
over. Shortfalls are assessed as
they occur
Innovative Self-Funding Models
• Collaborative Purchasing – One Example is Veris/Benecon
• Average client size is 97 employees, though they do have clients with
several hundred employees
• Each employer funds actual claims up to a defined threshold
• Renewals and thresholds are developed by Veris using an the employer’s
actual claims experience and demographics blended with the Veris’ book of
business data
• Stop-loss is group purchased and the corridor of risk ranges from 10% to
20% of expected claims (instead of the normal 25%)
• Employers fund claims up to those thresholds with annual maximum
funding guaranteed over 150 employees and monthly funding guaranteed
under 50 employees
• Client retains 100% (never spends) surplus and no deficit carry forward
• Network options include Cigna or Blue Cross networks
43
Innovative Self-Funding Models
• Reference Based Pricing – Self Funding Only
• Procedure focused
• Includes non-urgent procedures with wide price variations
• Some common bloodwork
• Imaging such as CT Scans an MRI’s
• Outpatient procedures such as colonoscopy
• Non-urgent surgeries like hip and knee replacements
• Often via a carrier TPA
• Facility focused
• Uses a provider network; eliminates facility network
• Sets reference reimbursement at 1x% of Medicare (usually 70th to 80th
UCR) and plan excludes charges above that
• Engages a third party to negotiate the balance bill to $0
• Adds a reimbursement plan to make employee whole if negotiations fail
44
NFP Team
Amy Coyle
45
John Casey
and me, Elizabeth Patterson
Thank you.
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