HRA or MERP Brainstorm

[jgrabe]

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.

[GBurns]

You seem to have complicated a simple issue, so it is likely that I do not understand what you have described.

It seems that all you want is a group health insurance plan with a $5,000 deductible and Rx coverage. The employer will also fund a MERP to cover expenses after the first $500 up to a limit of $5,000.

It should not be hard to find such coverage as long as you do not complicate the issue as you have done in your post.

[jgrabe]

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!

[leevena]

What you want to do is easy, it's called an Agg Only. There are a few carriers out there that do this. Dont' know where the group is, so cannot guarantee that it's available in that state. You may want to also consider a level-funded self-funded plan too. As a rule of thumb, level-funded plans should have a lower fix cost.

Available to discuss if you would like.

[jgrabe]

Please reach out to me at 352-208-0336

[GBurns]

I really felt that I was not understanding you. Thanks leevena.

[jgrabe]

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...

[leevena]

Don't be too surprised, the math is working against you anyway. The group has a community-rated plan, which is akin to an average cost in your area. To be cost competitve it means that this group needs to be below the community rate. The math tells you that half the groups in this area will be below the community-rate.

Sorry, don't know any tpa that will do this. All of the tpa's that I work want the stop-loss, otherwise they can't make any money. Sure this is one out there, just don't know them.

[GBurns]

The provider of the FIHDP would most likely be the best choice for administering the MERP. They should also be to point you to a few TPAs who are set up for this.