This is ClaimLinx’s premier product, the trailblazing solution for purchasing benefits at a lower cost. In the simplest terms, a Simple Option Solution plan combines a high deductible insurance plan from a major carrier with a company self-funded Medical Expense Reimbursement Plan (MERP).
The high deductible plan provides a stop-gap for the company in case of high employee medical costs as well as a comprehensive physicians network, which typically includes discounts for office visits and procedures. The company MERP provides the benefits people are used to, including a lower deductible and copays for regular visits and procedures.
Claims are processed first through the high deductible plan with a major carrier. Then they go to ClaimLinx as third party administrator for the company MERP to determine the correct payout for both the company and the patient, according to the company’s customized schedule of benefits. See the process in a diagram.
Each client’s Simple Option Solution plan is different, based on the benefits it provides and the high deductible insurance plan, or plans, chosen as its base. This can be a group plan, a combination of group plans or even individual plans — all based on the client’s needs and its employees. The plans work as a way to provide great benefits without paying high premiums to an insurance company for services employees are not using.