Third-Party Administrator ClaimLinx

What Does a Third-Party Administrator Do?

ClaimLinx is a full-service insurance company. We take care of anything and everything, such as finding the best possible employer-paid benefits and competitive health insurance rates. But at the core of the ClaimLinx Solution our consultants use, is the third party administration we offer employers. Today’s blog from ClaimLinx explains what a third-party administrator does for businesses.

Definition of a Third-Party Administrator

A third-party administrator accepts and processes medical insurance claims from healthcare entities and patients. Think of this as a service that makes sure everyone’s paperwork lines up with what’s covered, what’s not, and who pays what in terms of health insurance coverage. They connect and communicate among health insurance providers, employers, healthcare companies, and people who file health insurance claims for payment. Third-party administrators are experts in their field, and they typically only work with insurance.

Related Post: See ClaimLinx’s Complimentary Elite Services for clients

Duties of a Third-Party Administrator

Many employers choose to self-fund employee healthcare plans, and technology makes it possible to streamline payments to healthcare providers. However, a third-party administrator takes the hassle out of this process. ClaimLinx ensures everyone fills out the proper forms and that each participant receives the right amount of money. Employers and employees log in to our convenient online system to see their forms, claims status, and finances on a health insurance plan. Our team reduces paperwork and educates everyone on how to file claims for coverage.  

What ClaimLinx Does

ClaimLinx accepts claims from employees and providers and processes them to determine the correct payout for the employer and the member. We keep track of each client’s custom schedule of benefits and each member’s usage. Meaning we track who has hit their deductible and through which claims. All of that data lets our team help when it comes to finding new ways to save. Our system works for medical, prescription, dental, and vision coverage. We process claims and payments to providers and members while following strict HIPAA guidelines for privacy. Our team works for you, not for insurance companies. With Claimlinx as your third-party administrator, you and your workers are our top priority.

Related Post: What is an employer-sponsored, or self-funded, plan?

Hire ClaimLinx as a Third-Party Administrator

ClaimLinx does so much more than serve as a third-party administrator. We offer the security and convenience of all of your healthcare resources in one platform. Our employer benefits consultants teach employees how to take full advantage of their health insurance. Contact ClaimLinx or call toll-free 1-800-858-1772 to find out about the ClaimLinx Solution for your small business.

ClaimLinx Health Insurance Benefits Consultant

ClaimLinx Glossary: Secondary Coverage

You offer fantastic health insurance for your employees. It gives them peace of mind for themselves and their families in case they have expensive medical bills. However, the plan couldn’t possibly cover every single type of high-tech MRI scan, prescription medication, or medical procedure. Then secondary coverage comes into play. ClaimLinx explains precisely what secondary coverage is, and how it can save your employees money on their healthcare costs.

What Exactly Is Secondary Coverage?

Simply put, secondary coverage is any health insurance plan that supplements your main plan. Your primary plan usually comes from your employer. ClaimLinx uses secondary coverage as a way to restore good benefits to employees. One of the first steps in using the ClaimLinx Solution is to raise the deductible on the primary plan in order to lower premium costs. But that means employees would have to shoulder most of the costs for office visits, prescriptions, testing, etc. A secondary plan can pay for the medical expenses not covered by your primary plan. This is why secondary health insurance represents a vital tool for helping employees pay for health care. The ClaimLinx Solution sets up a custom secondary plan for your employees, called an employer-funded medical expense reimbursement plan (MERP)

Related Post: What is the difference between primary and secondary coverage?

How Does Secondary Coverage Work?

A primary plan pays money directly to healthcare providers while you pay the balance. Secondary coverage pays you directly to reimburse you for expenses not covered by the primary plan. Or secondary coverage can also pay medical providers directly so employees don’t have to. For example, your primary plan covers 60 percent of the costs of an MRI, and you receive a bill for $1,000 for the scan. You must pay the $400 not covered by the primary plan. Your secondary coverage would pay part or all of that $400. The added benefit with ClaimLinx is that employees experience seamless administration. They don’t have to worry about paying that $400 up front. They arrive at the provider’s office with a custom ID card with benefits listed. ClaimLinx then takes care of the rest.

What Does Secondary Coverage Pay?

Secondary coverage might pay for medical care not covered by your primary plan, including eyeglasses or visits to the dentist’s office. A secondary plan may cover copays and coinsurance to help alleviate the costs associated with the primary plan. Some secondary coverage specializes in paying for expenses related to accidents, critical illnesses, cancer, long-term care, and disabilities. ClaimLinx’s Solution aims for employees to receive the same benefits as an expensive plan from a major carrier. Secondary coverage can pay for that, but at a much lower cost.

Related Post: What is the ClaimLinx Simple Option Solution?

Why Have Secondary Coverage?

The average person in the United States spends $10,739 per year on healthcare. Secondary coverage can help you spend less money on healthcare, which may insulate your finances from high medical bills. Consider a secondary plan if you know you’ll have high medical expenses in a given year. The ClaimLinx Solution finds the best way for employers to save money while giving workers a great employer-paid benefit.

ClaimLinx and Secondary Coverage

ClaimLinx can save companies as much as 40 percent on health insurance costs. Contact ClaimLinx or call toll-free 1-800-858-1772 to find out what we can do for you.

MERP ClaimLinx

ClaimLinx Glossary: Medical Expense Reimbursement Plan (MERP)

A medical expense reimbursement plan (MERP) is part of the ClaimLinx Solution. A MERP allows business owners to make a tax-deductible contribution to employees’ medical expenses. Our employer benefits consultants combine a high-deductible health insurance plan from a national carrier with a MERP. This arrangement gives both workers and owners an optimal choice for health insurance benefits. Today’s ClaimLinx blog defines and explains how a MERP works with regards to health benefits.  

Short Definition of a MERP

A MERP lets business owners deduct any portion of medical expenses paid by the company or employees for their medical care. The idea is to reduce the out-of-pocket expenses that employees pay for medical care before health insurance starts to cover the costs. Contributions to these costs lower the amount of money the IRS calculates for a business’s income taxes. ClaimLinx helps you find the optimal funding levels for MERPs to give you the best way to provide health insurance for workers.

Related Post: Why did my employer purchase a MERP?

Example of How a MERP Works

Suppose ClaimLinx has determined a plan with a $3,500 deductible works best for your company. That means the employee would normally pay $3,500 before the health insurance coverage starts paying for his or her medical care. A MERP can help lower someone’s up-front costs for medical care. ClaimLinx designs a custom schedule of benefits for you and your employees based on medical needs and company budget. In this case, the employee would actually have a much lower deductible and may even experience copays for regular visits and procedures. Business owners receive the tax deduction only when an employee has a qualified medical expense when they pay part or all of the medical expenses.  

Why Employers Need a MERP

All the time, employers tell ClaimLinx they would not be able to have viable health insurance benefits without a MERP. Small businesses often have slimmer margins and can’t afford good benefits when premium costs go up. MERPs allow employers to keep offering great benefits on a smaller budget. When you take the administration of first-dollar benefits like copays for office and specialist visits away from the insurance company, you don’t have to pay as much for those benefits. The flexibility of MERPs let companies fund their employees’ medical expenses based on the budget and needs. And as a bonus, MERP funds transfer from year to year. So a company can build up funds over time. 

Related Post: HSA vs. HRA vs. MERP

The benefit to the company is also that MERPs lower the income that goes towards a tax liability. For example, a business owner has $500,000 in income in one year. The owner has $10,000 of qualified expenses he reimbursed for employees through the funding program. The owner does not pay income taxes on the $10,000 he contributed to that fund. At a 23.6 percent tax rate, the business owner pays $2,360 less in taxes for that $10,000.

ClaimLinx Navigates MERPs for You

The employee benefits consultants at ClaimLinx help business owners select the correct funding levels for MERPs, so employees save money on health insurance costs. Not only do owners lower their costs, but they also help retain employees with lower-cost employer-paid benefits. Contact ClaimLinx or call toll-free 1-800-858-1772 for more details on our ClaimLinx Solution.

ClaimLinx Health Insurance Strategy

ClaimLinx Offers a Full-Service Insurance Strategy

ClaimLinx offers more than just a way to provide health insurance to your employees. We offer a holistic solution to give great benefits to employees while saving money for business owners. Our ClaimLinx Solution blends a high-deductible insurance plan with a company-funded medical expense reimbursement plan (MERP). The result is an optimized health insurance plan for everyone at your business. ClaimLinx explains how we make this full-service insurance strategy work in today’s blog.

High-Deductible Health Plan

A high-deductible health plan allows for lower monthly premiums. Lower premiums mean you pay less money to have the health insurance plan in place. Normally, higher deductibles mean employees must pay more money before insurance coverage begins to pay for medical expenses. But ClaimLinx has a different strategy.

In 2019, the IRS defined a high-deductible plan as one with at least $1,350 for an individual or $2,700 for a family. These minimums mean individuals must pay the first $1,350 of medical expenses before the health insurance plan starts to cover certain costs. But ClaimLinx typically chooses plans with deductibles much even higher to really slash expenses on premiums. This is a part of our full-service insurance strategy.

Related Post: What is an employer-sponsored, or self-funded, plan?

MERP

Employers can use a MERP to help fund an employee’s costs before reaching his or her deductible. When paired with a high-deductible plan, MERPs offer a health insurance strategy that is cost-effective for employees and employers. 

For example, John Smith goes to the emergency room for a minor injury and receives a bill for $2,500. His insurance carrier sends him an Explanation of Benefits (EOB) that says he owes the full amount because he has not yet met his high deductible of $3,500. John’s employer, Acme Brick, has a MERP that covers emergency room visits with a $350 copay. That means John only pays $350 instead of $2,500. 

The ClaimLinx Solution is a win for everyone. John Smith experiences lower costs for medical expenses. Also, John’s employer is happy because he can afford to offer such great benefits since the cost of the company’s monthly premiums has gone down so much. Our full-service insurance strategy identifies the optimal combination of high deductible plan and MERP.

Related Post: What Is a MERP?

How This Strategy Saves Money

A high-deductible health plan lowers the monthly premiums for each employer. Instead of paying $1,000 per month for a family’s coverage, an employer might pay $700. A MERP continues the savings because it’s a tax deduction. Every time an employer reimburses an employee’s medical expenses, it lowers the amount of money the IRS figures into business taxes. Business owners not only pay lower income taxes, but they also lower onboarding costs by retaining employees for longer periods of time. Employees who remain healthier are more productive and miss less work. ClaimLinx shows you how we deliver for both business owners and employees with our full-service insurance strategy.

The ClaimLinx Solution: A Full-Service Insurance Strategy

ClaimLinx is here to find the best possible solution for health insurance at your business. We educate business owners and employees on the best practices for combining health insurance plans with a MERP. Our team provides third-party administration, employer benefits consulting, and complimentary elite services to our clients. Contact ClaimLinx or call toll-free 1-800-858-1772 for more details about our full-service insurance strategy.

ClaimLinx Health Insurance Rates

Why Insurance Rates Are So High and How to Start Cutting Them

ClaimLinx understands that health insurance rates are high, and they keep going up every year. Our experienced benefits consultants work with business owners to keep insurance costs low for you and your employees. In today’s blog, ClaimLinx explains why insurance rates are so high and how to start cutting them.

Why Health Insurance Rates Are So High

Health insurance rates are high for several reasons. Investopedia states that administrative costs are the number one reason why health insurance costs skyrocket. Healthcare companies need billing clerks to determine what is or is not covered by health insurance. Around one-fourth of healthcare costs are due to administrative costs. Considering overall healthcare costs were a whopping $3.65 trillion in 2018, administrative costs were around $912.5 billion. 

Related Post: ClaimLinx saves small businesses $4.5M on health care in 2018 

Defensive medicine is another reason for high health insurance rates. Doctors err on the side of caution when it comes to trying to diagnose patients. Someone might get an MRI, bloodwork, and a biopsy just for one visit to the doctor’s office. When more people get more tests, health insurance costs increase. Defensive medicine adds nearly $50 billion to the costs of healthcare in the United States. 

How to Cut Health Insurance Rates at Your Company

Health care and insurance costs are increasing at an unprecedented rate, and that’s why you need a creative solution. ClaimLinx devised a method for savings that works. It’s called the Simple Option Solution. It combines a high deductible health plan with a self-funded plan, and it saves small businesses 20 to 40 percent on their health plan. There’s no reason to keep giving your company’s hard-earned money away to the insurance company. You can take back control with a new method of buying employee benefits that is less expensive and more flexible.   

Related Post: We are the full service insurance benefit solution

Be Flexible

Flexibility is a way to save money on health insurance rates. While group health insurance might work well for some small businesses, individual benefits consulting and shopping for plans in a marketplace might make more sense for others. Implementing the ClaimLinx Solution is about looking at all aspects of the plan, from the plan with a carrier to the prescription coverage, from the copays for office visits to the overall plan deductible. ClaimLinx can help you find the right options for the best possible costs.

Educate Your Employees

Educate your employees on how to seek healthcare options and take better care of their health. Consider anti-smoking or anti-tobacco campaigns if your company has smokers on staff. Where employees seek medical care can also affect their health insurance rates. ClaimLinx can explain how someone’s choices to seek medical care can make health insurance rates go up. We go over urgent care versus an emergency room visit, out-of-network versus in-network care, pre-tax payroll deductions, and wellness initiatives for workers. 

Hire ClaimLinx to Lower Health Insurance Rates

ClaimLinx offers the ClaimLinx Solution to help lower your health insurance rates. Our experienced health benefits consultants can find you the best possible rates on employer-paid benefits while also educating your workers on how to save money on healthcare costs. Contact ClaimLinx or call toll-free 1-800-858-1772 to see what we can do.