jgrabe

I have a client with a Group Health Plan that has experienced excessive utilization with their Drug Card program. A solution being considered is to offer a Base Plan with Generic only, and let those who desire it Buy Up to the plan with Broader Drug Card Coverage. The company funds a $1000.00/year Health Reimbursement Plan that allows the assets to accumulate in each participants account. I am seeking a solution that would allow the $1000.00 being contributed currently, to a plan that will allow the employees to allocate that towards their portion of their employee premium if they choose. It that possible?

Ok, So I am actually back to square 1 on this. It appears that what I am seeking, no one can do cost effectively... Now I am just seeking a TPA that can administer a HRA with an Office Visit Copay and a separate deductible underneath the Fully Insured High Deductible Plan. Any Ideas? Thanks everyone for their previous assistance, it just could not be put together for less than a loaded Fully Insured low deductible plan... I am surprised...

Please reach out to me at 352-208-0336

Yes you do not seem to understand the question posed. The issue is the 5000 x 120 lives equals a 540,000.00 potential liability to the employer. He would like to limit that exposure to 50,000.00 and purchase a separate insurance policy to indemnify him from losses that could exceed that amount. If 30 people met their 5000 deductible that would equate to a 150,000.00 bill to the employer, on top of the monthly premiums. That is unacceptable at this juncture, or at least a possible outcome I would like to insure against, if possible!

I am considering a 5000.00 Deductible Plan to offer a Long Term Client. The plan will have Office Copays and a Drug Card so it is not an HSA compatible plan. The group has about 90 employees, some of which cover dependents which brings the total number of insured lives to about 120. The employer would be comfortable in self insuring through an MERP the first 4500 of claims after applying a 500 deductible, so long as he could cap his maximum exposure to as an example 50,000 per year. Can I find an insurer to cover the potential difference of 120 lives reaching their 4500 MERP limit? I can envision the MERP or HRA being administered in such a way that at the end of the plan year only, any expenses that exceed the 50,000 self insured portion are submitted at a single time. In other words, the employer pays over the course of the year 75,000 in medical expense and applies their 50,000 first, and then submits the 25,000 on to the reinsurer as a single claim.