What is the ClaimLinx Simple Option Solution?

The ClaimLinx Simple Option Solution is ClaimLinx’s premier product. It’s our trailblazing solution for purchasing employer-paid benefits at a lower cost. In the simplest terms, a ClaimLinx 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 health insurance plan provides a stopgap for the company in case of high employee medical costs.  A MERP also utilizes 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 health insurance 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 this process in a diagram.

Each client’s ClaimLinx Simple Option Solution plan is different, based on the benefits it provides and the high-deductible health 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 health insurance plans work as a way to provide great benefits without paying high premiums to a health insurance company for services employees are not using.

Tom Quigley Explains How to Use Tax Law to Save on Health Insurance

A lot has changed for small business when it comes to providing health care.

With this in mind, business coach Laurie Althaus spoke to National Business Consultant Tom Quigley about what business owners can do to significantly cut health care costs using new — and some old — tax laws on her online radio show.

Related Post: Listen to Tom Quigley Talk About Obamacare on ClaimLinx Podcast

Now and Next Radio seeks to highlight businesses that are making a difference in the world, a primary focus at ClaimLinx. Listen to the full interview or read some of the highlights below.

Tom Quigley: We’re showing people here at ClaimLinx how they can reduce their health insurance costs and provide better benefits to employees taking advantage of the new tax law that everyone was blessed with called the Affordable Care Act.

Laurie Althaus: That affordable care act, how does that apply to small businesses?

TQ: Well, every small business owner has the decision to make, whether to offer benefits or not, and there’s a lot of misinformation out there for smaller businesses, those under 50, that they have to offer group health insurance or they cannot offer benefits at all.

What we’re trying to help people understand is there’s better options than what the insurance agents and insurance companies are offering in terms of their product to the consumers. We’re taking advantage of tax laws that have been in existence since 1954, and we’re taking advantage of laws such as the Affordable Care Act and tying it all in to provide a better benefits package that fits small business owners.

LA: So this is all based on a tax law, and you mentioned that the tax law was created in 1954 but then new legislation recently, that was around the health care act. Do those two coincide, or are they separate?

TQ: The tax law that I’m referring to from 1954 is the same tax law that Proctor and Gamble, General Electric and any self-funded health insurance plan in America uses. What people don’t realize that a small business owner can use it also. What we’re doing is showing people how to use it more efficiently than what Proctor and Gamble or General Electric does, using the Affordable Care Act. There’s certain things in this country that nobody should be doing today. But unfortunately they’re being advised to keep doing the same things over and over again. And I believe Mr. Webster and his great dictionary states that’s the definition of insanity.

Related Post: Tom Quigley Breaks Down Employee Expectations for Benefits

LA: Yes, we talk about that a lot, don’t we Tom?

TQ: Well, we know that I’m insane. We just didn’t know that the rest of America is.

LA: What do you find as the biggest challenge in selling the solution, or offering the solution?

TQ: Basic math sometimes does not prevail. What we need to focus in on health insurance is this: everyone who owns a home generally doesn’t buy plumbers insurance; business owners who own company cars don’t buy oil change insurance or gasoline insurance. But for whatever reason, they buy those benefits on their health insurance directly from the insurance carriers instead of doing it themselves. And what the law allows, the Section 105, is for the employers to self-fund items they don’t want to buy insurance on. And the law allows it to be tax-free to both the employer and the employee.

Schedule an appointment now to go over your company’s options for saving money.

Step-By-Step How a Claim Is Processed at ClaimLinx

There are a lot of positives to your employer choosing to switch to the ClaimLinx strategy of providing group health insurance:

  • You receive personal service regarding your benefits
  • Your employer can customize benefits to fit company needs
  • The company saves money when buying health insurance

But, if your employer has recently instituted a Medical Expense Reimbursement Plan for the first time, you may be confused about how your claims are actually paid. Check out our flowchart explaining the process, or see the steps below.

The entire process typically takes 30-60 days, from the date of service to when ClaimLinx sends payment to the health care provider.

Related Post: Tips For Helping Members With Claims Issues

Step 1 – Visit your physician

– The process begins when you visit your health care provider.

– Most important during this step is that you show BOTH your primary insurance ID card and your secondary ClaimLinx ID card.

Step 2 – Your provider bills your primary insurance

– Once your visit is over, your health care provider submits the bill to your primary insurance carrier.

– Your primary insurance carrier then determines your coverage and sends an Explanation of Benefits (EOB) to you and your health care provider.

Step 3 – Submit information to ClaimLinx

– In many cases, your primary insurance carrier will not have paid the entire bill for your visit. That’s OK; you still have secondary insurance.

– Now, you and/or your health care provider will need to submit the claim, bill and/or primary carrier EOB to ClaimLinx to be processed for additional coverage.

Step 4 – ClaimLinx processes your claim and sends your physician any applicable benefit

– Once ClaimLinx receives all of the correct information, our claims processing team determines any additional coverage from the Medical Expense Reimbursement Plan (MERP).

– ClaimLinx then submits any balance for applicable MERP benefit to your employer.

– Your employer pays ClaimLinx for this balance, and ClaimLinx sends a check to your health care provider

Step 5 – You receive a ClaimLinx EOB

– Once MERP coverage has been determined, ClaimLinx sends you an EOB.

– The ClaimLinx EOB will show any remaining balance you will need to pay your health care provider.

– If there is a remaining balance, you will need to send payment directly to your provider’s billing department.

Related Post: How to file a medical claim

You can also improve this process by sending ClaimLinx a list of your physicians. You can send the list by mail, fax or email to help@claimlinx.com. Once we have this, we send information to the physician’s office to introduce our company and explain the process.

September Sales Talk With Tom

Tom Quigley, Vice President/National Business Consultant, provides consulting services, and is in charge of recruitment and new business for ClaimLinx.

Related Post: July Sales Talk With Tom Quigley

Today Tom is discussing the niche ClaimLinx has developed by working with groups of under 100, as well as the importance of companies working with their tax advisor to guide them in making the decision to initiate a MERP plan. Please click here to view a short and informative video by Mike McCormick and Tom Quigley explaining which businesses can benefit from the ClaimLinx Simple Option Solution and how much they can save.

Related Post: Sales Talk With Tom – On Business Talk Radio Show

ClaimLinx is positioning its clients to move in the right direction. We can structure benefits in your favor to ensure you are in full compliance with the law without cutting benefits or employees. Please contact us at sales@claimlinx.com or(800) 858-1772 X 25 with your questions.

Our book, “How to Beat Obamacare” is available for purchase on amazon.com.

A Health Insurance Cost Control Success Story

“In February 2011, our Company was notified by our health insurance carrier that our group policy premiums would again increase at a rate that we knew was higher than our rate of net profit and higher than the rate of wage increases we could afford to give employees. We were also told to prepare for an even higher rate of increase in the future even if we reduced benefits in the plan design.

Later in 2011, management of our Company met Tom Quigley, representing ClaimLinx. He presented a concept for controlling healthcare costs while providing employees with the same benefits.

Related Post: ClaimLinx Client Service Success Story

Honestly, we were very skeptical. But, we try to look at and control all of our costs, so we knew we had to consider their concept and perform our due diligence to determine if we should try it.

We found that the concept was in fact workable for us. In early 2012, our group plan carrier informed us our premiums would increase 104%!  We proceeded to implement the concept ClaimLinx presented.

The commitment by our company’s benefit administrators and employees, along with the availability of ClaimLinx personnel to help, has resulted in our Company’s healthcare costs to be maintained close to the 2012 level without sacrificing benefits.

Related Post: The Right to Health Benefits

As we proceed into 2014, we have no guarantee of being able to maintain the cost or benefit levels. What we are comfortable with is that ClaimLinx provides us with our best chance to do both.”

Mike D., VP
Cincinnati Manufacturer

At ClaimLinx, this is just another example of how we save our members and clients money. If you have questions about a claim or need additional information, please email service@claimlinx.com. We would be happy to help.