How can the complex topic of group health insurance be condensed into 5 Design Components?  

We begin by focusing on the major driver for all that we do - The Consumer.  Our plan designs are focused and driven by the consumers’ desire and need to acquire better healthcare at a better price.  Because price is not the best indicator of the best health insurance plan we begin our conversations with the client's goals in mind.  By identifying the objectives that our clients are looking for, we, with the help of your broker, recommend the type of insurance plans that might accomplish those objectives.  Then we discuss, compute, and present financial expenses and savings.  After a plan design option is selected, we facilitate and implement the plan with a Third Party Administrator along with the education meetings with the employees. From identifying objectives to educating the employees everyone has the confidence that the Benefits Matrix Consumer Driven Healthcare Plan Design will meet deliver the objectives set in place.

Identifying Objectives:
Some of the most common goals we find when employers are looking to change or improve their healthcare benefits are to Lower Costs – Improve overall Benefits – Maintain choice for Employees – Increase Employee Awareness, and Empower employees in having a Financial Stake in their Healthcare Decisions.  Keeping costs lower is not just a benefit but a by-product of a market based approach to healthcare, and Consumer Driven Healthcare programs are at the center of that approach.  When individuals act like consumers and begin to understand that their decisions can have an impact on present and future costs, then companies are able curtail the dilema of rising costs in healthcare. 

CDHP, powered by a Health Reimbursement Account and driven by educated employees, improves utilization while driving costs down.

What are healthcare benefits?  Healthcare benefits are the monies we receive from health insurance companies to help pay for our healthcare.  The best benefits are derived from an insurance plan combined with a well designed HRA or HSA package with employee choices.  A typical example is of an MRI procedure.  An employee with an HMO doctor is often referred to an associated radioligist with typcial costs as much as $1,500.00.  An educated employee with an HRA plan design is able to make a few phone calls, and get competitive pricing and purchase the MRI at the lowest price, which could be as little as $500.00.  Result?  Less cost to the employee.  Less cost to the employer.  Lower cost to the insurance company - which translates to lower rate increases!

The best benefits are achieved through education and effort. 

When it comes to the most common objectives that employers are requesting, we have found that when educated employees are made aware of the choices available, they will increase their own benefits while reducing overall costs because they realize that with a Benefits Matrix CDHP package they now have a financial stake in their healthcare decisions.

Insurance Plan Selection:
Selecting a health insurance plan sometimes seems more difficult than purchasing a car.  There are many insurance companies with many options and variables and connecting the specifics together so that the result is a health insurance plan that meets your needs is a tremendous effort for the layman.  One of the variables is that for an HSA, the health insurance plan must be HSA qualified plan whereas with the HRA option any health insurance plan that meets the client’s objectives can be used.  Once that component is complete it is now time to design the specifics of your HRA or HSA Consumer Driven Healthcare Plan. 

CDHP Design:
A well designed plan will empower consumers and encourage behavior modification is the only way consumers will be able to reduce the cost of their own healthcare; they will do this by being educated on how their reimbursements are received, how their employers’ contributions are applied and through shopping for services, medications, and providers.

Consumers are going to become aware of the fact that Health Insurance Policies that have low deductibles, low co-pays, and have higher premiums are the equivalent of purchasing insurance for hamburgers, oil changes, and haircuts.  If you want your insurance company to pay for the little items like that then you are going to pay very high premiums. 

The HSA option has narrow parameters outlined in the IRS Regulations and is truly most effective for individuals and/or companies with ten (10) employees or less.  The HRA option has the most flexibility as we will discuss further.

For each insurance policy where quoted rates are received, Benefits Matrix will design an HRA PLan customized to the benefits of the insurance policy.  Then, unlike anybody else, we actuarially compute the cost of the HRA plan.  We consider deductibles, items subject to the deductible, maximum out-of-pocket limits and the census.  We also consider the insurance policy premium funding structure.  We can compute costs for dental inclusion, vision inclusion, and Code Section 213 inclusion.  This is the most sophisticated HRA porjections that you can find.

TPA Selection:
Benefits Matrix works with the top Third Party Administrators as determined by experience and time in the industry.  There are many third party administrators and one of our requirements for a TPA to be recommended is that they have been working with HRA administration for many years.  We don't let them learn the ropes on your time and dollar.  Third Party Administrators are the organizations who take the employee phone calls, receive claims, process and issue reimbursements.  Their systems are established to accomplish tasks that are specific to certain health insurance plans, so the goal is to find and match a TPA to your specific Consumer Driven Healthcare Plan Design.  That is our job and that is what we do.

‘EE Education:
Changing buying habits is the result of educating employees about their healthcare plans.  People do not like to change, no argument. People will change though, given enough pain people will move away from the source of the pain.  Financial pain is a motivator and the healthcare industry has caused enough financial pain to last a lifetime.  Combine the financial pain with the horribly frustrating, continuous double digit increases in premiums and you now have an employee proactively looking for a solution.

When you tell an employee that they can spend their CDHP money with any pharmacy or doctors’ office that gives them the best service and price they will apply their shopping skills to their healthcare purchases.  They will be shopping for both quality of service and price, the best overall value!