| What
is the BeniComp® Advantage? |
| |
The BeniComp® Advantage
is a fully insured supplemental product that works
in conjunction with any health plan to reward employees for their
healthy lifestyle choices. Healthy employees incur fewer claims,
directly reducing health care utilization and resulting in lower
health plan costs for the employer. |
| How
does it work? |
 |
- Health plan deductibles on your base medical plan are increased
for all plan members reducing the overall cost of coverage to the
employer.
- Employees are voluntarily assessed for healthy lifestyle qualities
and qualify for wellness credits under a separate supplemental
policy from BeniComp® . This helps to offset the higher deductible
on the base plan.
- Employees receive one or more wellness credits through a unique
fully insured supplemental policy. By managing ones own health,
employees can earn their way to a lower “net” deductible.
Healthier employees mean fewer overall claims, offering a long-term
defense against escalating health care costs.
- Wellness credits apply to health criteria such as targeted body
mass index limits, controlled blood pressure, cholesterol and non-tobacco
use.
- Claims incurred are sent to the core medical plan administrator
for processing. Any amounts subject to the plan deductible are
forwarded to BeniComp® for adjudication under the BCA policy.
- Payments are made directly from BeniComp® to Employees.
BeniComp® will pay up to the amount each employee earned in
lifestyle wellness credits.
- Employers save money now by cost shifting and later by decreased
utilization.
- Money saved can be used to provide employees with programs and
tools to help them improve their health and qualify in future years.
|
| Is
this allowed under HIPAA? |
|
BCA has been structured to comply with non-discrimination requirements for wellness plans. Refer to our HIPAA Position Statement. |
| How
often is the screening done? |
|
The screening is performed
once a year, prior to the new plan year. |
| Will
spouses and dependent children be screened? |
|
Not typically. In most
cases only the employee will be screened. The employee’s results
determine credits available to each dependent. If an employer does
want to screen spouses or other dependents, higher screening costs
and premiums apply. |
| How
much does the screening cost? |
|
The cost of the screening
varies by geographic region, for the above criteria it ranges from
$35-$55 per medical screening. |
| Who
pays for the screening? |
|
The cost for the medical
screening is paid directly by the employer or submitted as a claim
under the wellness provision of the underlying health plan, if applicable
. |
| Who
arranges for the screening? |
|
BeniComp® has contracted
with a national lab to provide this service at your worksite. We
make all of the arrangements. We have also made arrangements for
individuals, such as out of area sales representatives be screened
as well. |
| Does
everyone have to participate? |
|
No one is required to
participate in this program. It is entirely voluntary and up to each
individual. However, by not participating, individuals will be responsible
for the entire deductible, no credits will be awarded. |
| How
will the employees receive the results? |
|
Test results will be
sent to the individual’s home, in a HIPAA compliant manner,
with an explanation of the results and the credits they qualified
for. |
| Will
I get the results as the employer? |
|
As the employer, you
will not see the actual test results; however, you will be provided
a summary showing total credits earned and average scores. |
| What
about employees hired after the first of the year? |
|
BeniComp® will arrange
for the new hire to be screened and participate in the program regardless
of when they are hired. |
| Can
BeniComp® Advantage be implemented anytime? |
|
Yes, the BCA program
can be implemented anytime during the year. We would add a fifth
credit category. This credit would equal the amount the employee
has paid toward their deductible as of the effective date of the
BCA program. |
| Are
exceptions granted for individuals genetically predisposed to any
of the categories being screened? |
|
If an employee has to take medication to achieve the desired results they will still qualify for the rewards available. Additionally, if it is medically inadvisable or unreasonably difficult due to a medical condition for an employee to attempt to achieve the goals, they may receive an alternative way to earn the reward. Supporting documentation from their physician is required. |
| How
much money can employers expect to save? |
|
Savings are found
by:
- Reduction in health care claims due to healthier employees
and the higher deductibles 12%-30%
- Lower aggregate attachment points and premium, many will experience
12%-18% net savings including the cost of the program
- Employees with significant risk factors identified during the
screening will receive a “critical notification” and
be advised to see their physician.
- Discounted specific premium rates, if the employer is on an
ASO the savings is directly reflected in the employer’s
bottom line
- Employees who choose other health care options
|
| Can
this be integrated with my Disease Management Program? |
|
Yes and is recommended.
With the medical screening, the information can be sent to your Large
Case Management Company as well as the Disease Management Company.
This information becomes very powerful and can be used to initiate
LCM or Disease Management prior to the trigger of a claim. This allows
you to catch, and truly manage the claim, before the claim takes
place, making a difference in the cost and more important, the life
of that individual. Many times the savings derived from BeniComp® Advantage
more than cover the cost of wellness tools and Disease Management
programs. |
| Will
BeniComp® help explain the program to my employees? |
|
We will provide communication
templates and suggestions for you to use with the employees to help
explain the program. |
| This
seems aggressive. How do most employees react? |
|
If you have been encouraging
consumerism in your health plan by raising deductibles, eliminating
co-pays and increasing coinsurance, this policy is a natural progression.
Employees understand that the company cannot continue to provide
rich benefits with plan expenses outpacing profits 5:1. Some employers
have suggested that like auto insurance, those employees who are
doing what they can to lower their risk of serious illness receive
the equivalent of a “safe driver discount”. Employees
understand this concept and receive it very well. |
| Will
the employees receive an insurance policy from BeniComp® Advantage? |
|
Yes. In the case where
an employee qualifies for the credits under the plan, a certificate
of coverage under the group policy will be issued to the employee. |
| Can
the employees take the policy with them when they leave the plan? |
|
Yes, the employee can
continue on the on the BeniComp® Advantage plan if they continue
on the base medical policy under COBRA. The Advantage product is
a “supplement” plan and must be in conjunction with a
base policy. COBRA rates will be provided. |
| How
do I encourage employees to improve their health? |
|
The employees experience
the rewards offered through a BeniComp® Advantage plan and are
given financial incentives to make positive lifestyle changes. Attaining
one or more of the wellness credits provides a direct financial benefit
that reinforces positive lifestyle choices. Many employers choose
to use part of their savings to pay for wellness programs like weight
management, smoking cessation and maternity care. You can also cover
the cost of asthma, diabetes, and heart programs. |
| How
soon will I realize a savings? |
|
Immediately. Since deductibles
will be raised, the amount of money that the employer pays will decrease
beginning day one. Once employees improve their lifestyles, you will
see a significant savings in reduced claims. |
| Is
BeniComp® Advantage available in all states? |
|
The BeniComp® Advantage
fully insured supplemental policy has been filed and approved in
many states. Please call our office to determine if your state has
provided final approval of the BeniComp® Advantage product. |
| What
is the AM Best Rating? |
|
BeniComp® Advantage
only works with carriers that are AM Best rated of A – or higher. |
| Is
there a cost for the BeniComp® Advantage? |
|
Yes, as with any fully
insured supplemental insurance product there is a premium associated
with the plan. This cost is minimal compared to the savings achieved
in the plan. On average plans will benefit from a 12-18% net savings. |
| Do
I have to change administrators? |
|
Not necessarily. As
long as your administrator is able to comply with the EDI and EOB
requirements, we are able to coordinate the administration of the
product seamlessly for you and your employees. If your administrator
is not able to comply with our requirements, BeniComp® offers
a full turnkey solution and would be happy to provide full administration.
BeniComp® is licensed to administer both self-funded and fully-insured
products on a national basis with state of the art technology. Working
with BeniComp® as the administrator provides one-stop administration
and coordinated customer service for your employees. If you are interested
in our administrative services, please contact our office. |
| Can
an employee qualify for credits mid-year? |
|
No, an employee can
only qualify for the credits on an annual basis in conjunction with
the setting of the annual plan deductibles. |
| Can
an employee still participate if they have a pre-existing condition
or taking medication for a serious condition? |
|
Yes. This program rewards
healthy lifestyle qualities. Pre-existing conditions will not adversely
affect coverage. In fact, even individuals with high blood pressure
and high cholesterol can receive credits if they are following the
treatment regime prescribed for their condition and fall within the
criteria set for the wellness credit. |
| Can
the plan be used with an HSA? |
|
Yes. If you are interested
in magnifying the power of the Advantage health credits through the
use of BeniComp’s® HSAdvantage program, please contact
our office and we will be happy to further explain how the program
works. |
| Why
not just implement an H.R.A or H.S.A.? |
|
Although there are similarities
in concept, these programs focus more on cost shifting than dealing
with the root cause of claims, unhealthy lifestyles. Additionally,
even the most innovative programs than have linked health risk assessments
and blood screenings to H.R.A contributions are faced with uniform
coverage rules, Section 125 limitations or tax consequences and typically
award credits for participation, not for results. BeniComp’s® unique
patent-pending tool is the only product positioned to financially
reward employees for taking control of their health.
As noted above, BeniComp® can work with
any health plan including those with an H.R.A or H.S.A. feature.
To implement those programs alone however may not do enough to
move employees to healthier lifestyles and many times employer
groups actually increase their costs in the first year to introduce
the concept. In the BeniComp® model employers save immediately
and give employees the ability to earn a lower net deductible. |
| Are
Prescription Drugs eligible for reimbursement? |
|
The BeniComp® Advantage
policy is a “deductible reimbursement” policy. Although
we recommend that employers maintain wellness benefits (immunizations,
physicals etc.) and prescription drug benefits outside of the high
deductible, we cannot require such changes to the base plan. Whatever
is subject to the plan deductible is eligible for reimbursement under
the BeniComp® Advantage policy. |
| If
a person earns all the credits they may actually have a better
benefit then before. Can BeniComp® apply coinsurance to the
payment of the deductible reimbursement claims? |
|
If, for example, a plan
had a $500 deductible then paid 80% of the next $3000 an employee
would have a maximum out of pocket expense of $1100 ($500+$600).
If that same employee qualified for all four credits at $500 each,
the net out of pocket to the employee would be $700 ($500+$200),
thus a better benefit. Many employers like this concept and think
that it makes for an easier “sell” to employees. If, however,
an employer wishes to make the best-case scenario equal to the non-BCA
plan, we can pay credits using a coinsurance model. Every deductible
reimbursement claim would be paid at 80% thus making the $500 credit
worth $420 to the employee. It is the employer’s choice. |
| What
should I do next? |
|
Call our
office and we will walk you through the detailed steps of this program
and help you take the first step that will truly control the cost
of your claims. Call us at 260.482.7400 or toll free at 800.837.7400. |
