Managed Care Benefits

[Guest JulieJ]

Does anyone have any suggestions of where to get information regarding managed care benefits? Basically, I would like to know what can be offered, how they can be offered, rules/regulations that apply to such programs, etc.

One of our clients is looking for other options to offer their employees (aside from their self-funded health plan) in order to control costs better.

Any information, websites, resources that anyone knows of would be most helpful.

Thanks!

[mroberts]

Your best bet is to touch base with each of the carriers to find out what is available. While medical insurance products are fairly standard everywhere in the U.S., the products have to be filed in each state, and therefore, differences will be found due to state regualtions.

There has to be a TPA involved paying the claims and most likely this TPA is using an insurance network, so that's a good place to start. I would first determine what kind of plan you are thinking about - HMO, POS or PPO. From there, I would find out the carriers that can offer these plans in the necessary states. Are you a benefits consultant?

[Guest JulieJ]

No, not a benefits consultant, but a TPA. The consultant for our mutual client is asking us what we know about managed care/DC plans, so that information can be presented to the client. We are just trying to help provide information, so educated decisions can be made. I think I used the wrong lingo (i.e., managed care) initially, and I really need information on defined contribution plan set-ups.

I read some of the posts in another thread [Health Plans (including COBRA and HIPAA) "DC Health Plans" posted 2/15/2001 by Melinda] about DC plans including links to some articles. This was somewhat helpful. However, the more information the better. We only handle self-funded plans for our clients, and this particular client is wanting to possibly add a DC portion to their overall benefits in order to manage costs.

Any other thoughts or other directions you can point me in??

Thanks.

[mroberts]

There's a lot of stuff on the web about Defined Contribution Health plans, or consumer-driven as the carriers prefer to call them. Most of the carriers that offer these plans take over the TPA responsibilities, so I don't know how prudent it would be for you to research something for a lazy broker who is eventually going to move the business if it makes sense.

[Guest JulieJ]

Yeow! Good point. Thanks for the word of warning.

[GBurns]

I would have expected your client to have made the "consultant" present his/her proposal THEN have you comment on it. I agree with mroberts you would be helping a lazy broker, but then again he/she might just be incompetent.

I saw a similar case recently and it turned out that all the other brokers had done a very good job of negotiating with the various carriers, so the only thing that this "consultant" could find to do was to inject something new, a DC ehealth plan about which they knew nothing. It turned out that it was not even available in that state. But it certianly sounded great and cutting edge at the start.

I also suggest that you repost your question to the Health Plans Board.