Cash in on savings on prescriptions

Consultants look at drug costs to find savings

ClaimLinx analyzes each company’s drug usage to find cost-cutting measures. First, it saves employers money. Most importantly, it helps workers be able to afford the medications they need consistently.

Why ClaimLinx Focuses on Rx Costs

Medications are one of the most important tools people have to maintain their health. However, prescription drug costs keep rising each year. By the end of last year, more than 20 generic drugs had a price increase of 29.4%. Also last year, the cost of more than 1,200 drugs rose by 5-6%. It’s a trend that has so far continued into 2021.

What research has shown is that when medication are expensive, people do not fill the prescription or do not do so consistently. In fact, between 20-30% of prescriptions are never filled because of costs. Up to 50% of medications for chronic illnesses are not taken consistently because they’re too expensive. That all adds up to a real impact on members’ health.

That’s why ClaimLinx prioritizes savings on prescriptions. We know it’s important for employees to take their medications consistently to be productive at work. We also know employers don’t have endless funds for drug coverage. To help with that, we focus on finding a balance between the two.

How ClamLinx Saves on Prescriptions

Our consultants get real-time data on prescription usage through our partner pharmacy benefit managers (PBM). Unlike with a standard insurance plan, ClaimLinx sets up a prescription drug plan with a PBM we trust. That allows our consultants to see which medications workers need and how much they cost. From there, our service team has many methods they can use to cut costs on prescriptions. That saves money for both the employer and the employee.

Enrolling in drug coupon programs

One of the ways ClaimLinx cuts costs on prescriptions is by researching drug programs and coupons for medications. These are many coupon programs through the manufacturers and through different pharmacies. There are also cost sharing programs available for those with financial need. We seek these out because they help the employer. But more importantly, they help the employee afford the drugs they need to stay healthy.

Moving members to a new plan

Another cost-saving measure is to move certain members on the plan to new health insurance plans with more prescription coverage or discounts. For some members, it makes more sense for them to be on a more comprehensive plan. The plan may be higher cost, but it will save in the long run if the drugs are expensive. Our agents are seasoned in taking this into account when finding members the plan that’s going to work best.

Finding generic version of drugs

As a part of ClaimLinx’s overall solution, we place an emphasis on educating members on costs so they can be good healthcare consumers. To help with that, we recommend members have an open dialogue with their providers about their prescriptions. We tell members to ask their doctors if they have chosen a brand name drug why that is. Is there an alternative that can achieve the same results. We also help workers research generic versions of brand name drugs, if they are available. Sometimes providers are unaware of the costs of prescriptions so it’s important to talk with them when the drugs are expensive.

Shows Schedule of Benefits at work

ClaimLinx customizes every client’s Schedule of Benefits

Every ClaimLinx client receives a custom schedule of benefits. ClaimLinx experts design it to fit the company’s needs, usage and budget. That is flexibility in plan design you can’t find anywhere else.

What is a Schedule of Benefits (SOB)

A Schedule of Benefits, or SOB, is a list of the services a health plan covers. It’s a record of the fees a member will be charged for certain standard services. Members receive an SOB at the beginning of their policy. It shows what treatments will be covered and at what dollar amount or percentage they will be covered. That way members know about how much the visit will cost before they arrive.

How ClaimLinx customizes SOBs

For any company that chooses the ClaimLinx Simple Option Solution, one of our expert consultants creates a custom SOB. For new clients, we typically base the first SOB on the company’s previous plan. That way there’s no disruption in coverage or benefits. It’s a seamless transition from a client’s old plan to the ClaimLinx Solution.

After the client has made the transition, our consultants look at usage throughout the year. That’s because ClamLinx is a third-party administrator. That means we process the claims in-house. This allows us to see how members are using the plan in real time. Using that information, our consultants can make adjustments to help the plan work better. With regular group insurance, employers never see how much their workers are using the plan. But with ClaimLinx, we’re able to tell you what services members are using. That way, we can tell you what changes to make to either cut costs or improve benefits.

Because the plan is not through a big insurance company, it does not have to fit a certain mold. We can change how much a member pays for specific services without having to change the entire plan. Also because this is all done in-house, it can be done quickly, even before renewal.  You will not find more flexibility in a health plan.

Why custom benefits are better

Being able to customize the health plan helps companies make sure budget and and benefit goals are in sync. Because our consultants can see actual plan usage, they can tell clients where they may be able to adjust the plan to lower costs. For example, we often see companies that have a lot of emergency room claims, which tend to be very expensive. In this scenario, we recommend raising the cost of those claims to the employee and lowering the cost of urgent care visits. That way, members are being taught and encouraged to find lower costs alternatives to going straight to the emergency room.

Custom benefits are also great because they can be adjusted to reflect your company’s specific needs and/or demographics. For example, a company with a lot of families may want to make sure the cost of office visits stays low to ensure children and parents can afford preventative care visits. Or, alternatively, a company with a lot of older employees may want to cover more testing procedures or prescription medications to help works afford to manage any chronic conditions they may have.

There is so much our consultants can do to make sure the health plan is working for everyone. It doesn’t have to break the bank. And at the end of the day, having healthy employees improves productivity for the company. That’s happy for everyone.

Talk

When was the last time your health insurance agent took a look at your company’s plan usage? How about when did he or she last bring you a DECREASE in your overall plan costs?

We’re willing to bet that’s never happened with your traditional insurance broker.

That’s something only a true consultant like ClaimLinx can do.

Not only that, ClaimLinx sits down with you to find out what benefits are important you and your employees. We take a look at the age, health and needs of your employees because we know every company is different. Some companies may have employees with low cost prescriptions. Others may want to prioritize keeping premiums as low as possible for workers.

We listen to what you need and then show you how to make it happen. Best of all, you know you’re getting a great deal on all of it.

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

What we offer our clients:

  • Plan analysis from a consultant when making benefit decisions
  • Personalized service from a team with experience
  • A customized benefit plan just for your company
  • Annual savings on a comparable plan

Our highest priority is to make sure our clients receive the employer-paid benefits they want at the very best price possible.

How we do this:

We do this through our unique ClaimLinx Simple Option Solution, an innovative strategy for purchasing benefits that combines a high-deductible plan from a major insurance carrier with a self-funded medical expense reimbursement plan (MERP). That way you get the best of both.

The high deductible plan provides a comprehensive physicians network and a stop-loss in case an employee has high medical costs. The company MERP provides the benefits people are used to, including a lower deductible and copays for regular office visits and procedures. That way you’re always only paying for the services your employees are actually using.

Related Post: What a Full-Service Insurance Agency Can Do for You

But it’s not just about getting health insurance benefits at a great price. It’s also about having a resource and true ally in an ever-changing industry. With our solution, clients have the opportunity to make employer-paid benefit decisions based on employee usage and company priorities. We aim to finally close the gap between your ideal benefits package and what your budget will allow. ClaimLinx helps both business owners and employees save money on health insurance costs.

SET UP A CONSULTATION TODAY

ClaimLinx helps auto dealer save money

It doesn’t matter what type of business it is. ClaimLinx can help owners and their employees save on health insurance.

The New Hampshire Auto Dealers Association found out just that when some of its members started working with ClaimLinx. On average, businesses that use ClaimLinx’s Solution save between 20 to 40 percent on their health plan within the first year.

ClaimLinx focuses on savings

Tom Quigley, Co-Owner of Claimlinx, said all it takes for business owners to start saving is a willingness to look at their health insurance differently. His company’s Solution combines traditional group insurance with a self-funded plan. That way employers can save money while providing great benefits.

“We have developed a solution on health insurance,” he said. “The main focus of our business is showing business owners how to use tax laws to greatly reduce the cost of health insurance for both the employer and the employees.”

A real example of savings for a small business

AutoServ Dealerships in Tilton, NH are members of the New Hampshire Auto Dealers Association who became clients of ClaimLinx two years ago. In the first year, they saved almost $100,000 on their health insurance. What’s more is they were able to pass that savings onto their employees as well. Their workers saved about 5 percent year over year while keeping deductibles lower than with the group’s previous plan.

Donna Gaudet Hosmer, General Counsel at AutoServ, said they turned to ClaimLinx because they needed a better option for health insurance at their company.

“The reason we chose ClaimLinx was primarily cost,” she said. “We needed an affordable option that reached a diverse array of employee needs in terms of benefits and affordability.”

How to start saving on health insurance

ClaimLinx works with businesses of all sizes. Qualified consultants are always available to start a consultation. They start by identifying each clients needs and balancing them with the costs of the health plan.

By taking the health plan out of the hands of traditional insurance companies, there is an amazing opportunity for savings while still providing great benefits. That means low deductibles and copays at a low cost to the employer.

Tom Quigley said for most companies this all comes down to setting up a plan that balances risk with savings.

“Really what the ClaimLinx solution boils down to is a math problem,” he said. “It’s really is as simple as putting a couple of keystrokes on your calculator. And to literally figure out the risk and the savings. What most people find is that the savings generated is greater than the actual risk associated. Meaning that every single person could go into the hospital or hit their deductible and the company still saves. That’s happening about 90-95 percent of the time.”

ClaimLinx focuses on education

This new way of buying health insurance isn’t just about the plan, though. It’s about educating employees on the best way to use the plan to get affordable healthcare. ClaimLinx turns its members into educated consumers so they no longer feel lost while navigating the health insurance industry.

Donna Gaudet Hosmer said the Solution was “definitely a departure from traditional insurance” but the people at ClaimLinx were there to help with educating members and providers on the new system. She said these resources were invaluable to members at the company. They were able to save money and still get the most out of the plan.

“The cost benefit far outweighs the learning curve to understand how to use it properly and maximize it,” she said. “So it’s been a huge win for us and I would highly recommend other dealers take a look at this.”

Contact ClaimLinx today to schedule a consultation.

Risk pools and small business medical insurance

Risk Pools and Small Business Medical Insurance

Small Business Insurance

Whilst starting a small business, there are many risk pools for which the insurance company offers various solutions. The primary focus of medical insurance is to achieve what is best for clients and to satisfy their clients, they offer them multiple options.

Health insurance policies are costly. Many investors do not invest in health insurance because it is challenging. There are risk pools and selection can be difficult when it comes to choosing a health insurance policy. We must choose which policy and company would be best for our interests and matches our requirements perfectly.

 

Risk pools

It is a group of persons whose medical expenditure would be pooled in order to analyze their premium. We must encounter risk pools in insurance. There are premium policies. One may balance between what is relative of low charge. A person with a complicated medical situation would prefer to select a scheme or policy which will serve him best i.e. higher premium policy. On another hand, a person who is healthier less likely to catch any disease will go for options that will serve him best i.e. a low premium policy.

The structure of health insurance policies was structured on less risk pooling in order for a more efficient and rational health facility scheme. In a system that includes less or little risk pooling, the citizens are accountable for costs. If money is not revolved between people then there would be less reasonable care in treatments due to low money. Thus, if there is totally no risk pooling then society would be burdened

There is a health risk after the retirement of people. The expenses that are revolving are limited. Thus if all the savings or the funds you had provided in past are consumed then there’s calamitous healthcare; limited resources.

 

Understanding Adverse Selection

The attraction of a disproportionate share of unhealthy people towards an insurer is known as adverse selection according to the American Academy of Actuaries. This problem arises due to the reason that the people with higher health care needs, when given the chance, are likely to purchase health insurance and to purchase health insurance with richer benefits than individuals with fewer health care needs. It creates problems for both insurance companies and insurance takers.

This causes a hike in premiums and not only this, due to this reason more healthy individuals opt for the coverage and cause an additional hike in the premiums. These changes in the premiums are usually referred to as a “premium spiral” in the industry.

To counter the effect of adverse selection risk pools are set up and to attract a broader range of healthy individuals. Not only this, but it also allows to equally divide the cost of sick or less healthy people. This is achieved by giving insurances to younger adults and healthy people from all age groups. It keeps the premiums at affordable prices for all members of the risk pool.

 

Small business:

Is it necessary to give employees of the USA their health insurance? Well, it depends there is a risk of offering a health insurance policy to workers. They can go for a new job for better remuneration. The immigrants go for private insurance if their boss doesn’t provide in contact.

Insurance for small businesses as a whole is very important. Small businesses are important and must be secured and insured. There are plans which cover the insurance of the company or small business you have started; to whatever level you want to achieve.

Insurers must opt for a single risk pool when they are going for premiums. It can be said, that the insurers should pool all their entity’s marketplace enrollees altogether when they are opting for the cost of their artifact. In other words, the cost of sick enrollees would be spread entirely enrollees i.e. the people who have signed up for the policy.

 

Small Business Options

The Department of Labor (DOL) increased the range to less expensive insurance plans for small business and their workers through Association Health Plans (AHP) as a result of Executive orders of President Trump “Promoting Healthcare Choice and Competition Across the United States.” on 19th June 2018.

This executive order allows small businesses and people who are self-employed to get together by the region or the industry they work for and get the insurance policy as one employer.

AHP’s improve the negotiating power with insurance companies by leveraging larger risk pools and greater economies of scale.

Despite the fact that becoming a part of large risk pool results in price reduction due to the size of the risk pool, there are various reasons these plans tend to be a lot cheaper.

Due to the fact that AHPs do not lie under the rules of the Affordable Care Act (ACA), they are not liable to provide 10 compulsory benefits provided by AHP.

SHOP, The small business health options program. Is a program for an employer that provides a marketplace to buy bulk health insurance in case they get on the merits of small business tax credits. It is necessary to have fewer than 25 full-time employees and pay under $50,000 average incomes per year and are able to pay 50 percent of employees premiums at the least.

More requirements include, at least 70% of eligible employees get the health plan except when they are an eligible waiver by getting insurance through their life partner or employer-based coverage.