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.

1095-A

WHAT TO DO WITH FORM 1095-A

In case, you or anyone in your family has decided to get insurance then you need to fill out Form 1095-A. You must get them to initiate the complete procedure of getting insurance. Form 1095-A is available at your Healthcare.gov account for all users.

 

What is Form 1095-A comprised of

Your 1095-A provided information about Marketplace plans anyone in your family has had including:

  1. Any paid Premiums
  2. Utilized Premium Tax Credits
  3. Your SLCSP (Second-lowest-cost silver plan)

You’ll use information from your 1095-A to fill out Form 8962, Premium Tax credit. This is often how you’ll “reconcile” — determine if there’s any difference between the premium tax credit you used and therefore the amount you qualify for and if you didn’t take any advance payments for your premium tax credit despite having Marketplace coverage.

 

 

Important Facts to Remember:

  1. Form 1095-A shall provide information about your family’s marketplace plans in 2020.
  2. It is important to keep this Form readily available and store it where you keep your tax information and other details.
  3. Keep in mind that the IRS does not provide Form 1095-A, you can get it from the marketplace.

 

How to find your 1095-A online

Your 1095-A is available in your HealthCare.gov account

  1. Below “Your Existing Applications,” go to our 2020 application.
  2. Choose “Tax Forms” from the left-hand side menu
  3. Save all the 1095-A files

In case you couldn’t find 1095-A in your account, you can reach out to the service center for any inquiries.

 

What to do if your information on Form 1095-A is wrong

It is very important to carefully analyze information filled out on your Form 1095-A in order to rule out any discrepancies.

Read the instructions at the back end carefully and make sure the information is accurate. If anything about your coverage or household is wrong, contact the Marketplace call center.  Also, it is very important to make sure that your SLCSP information is mentioned correctly.

 

How to know if your SLCSP information is correct

You can easily check your SLCSP information by following these steps:

You’ll notice Column B in Part 3 titled “Monthly SLCSP”. This would include facts and figures for all of your family members and their marketplace plans.

 

You’ll know that the SLCSP premium information is wrong if:

  1. There is a blank portion in Column B, Part III, or if it has a “0” during the months where your family members had the marketplace plan.
  2. If there were significant changes that weren’t communicated to the marketplace, i.e. getting divorced or married, losing a family member or having a baby, etc.

 

Use the knowledge from your 1095-A to “reconcile”

Once you’ve got an accurate 1095-A and your SLCSP premium, you’re able to fill out Form 8962 easily and reconcile your premium tax credit.

Find the Best Health Insurance

How to Find the Best Health Insurance

Shopping for a plan that is the perfect health insurance plan for you and your family is surely a challenging task. Meeting all the requirements and minimizing the cons can take a lot of research. However, there are some factors that help in narrowing your search and save plenty of your time and effort. Take a look at the following factors. We hope they may prove to be helpful.

 

Choose Your Health Plan Market Place

Many people are provided a health insurance plan through the company they work for. In case you are included in those people then you might not need to search for a government insurances plan or insurance marketplaces. The company you work for is your marketplace.

In case your company offers you a insurance plan, but you want to do a research about what other alternates are present then you are free to do that but it is a fact that they might be a lot more expensive. This is why the company tends to pay portion of the insurance premiums for their employees because on average the total premiums are lower.

You can buy an insurance plan from public marketplace on your state, if it is available. You may also search federal marketplace to find insurances with lowest premiums. The first step to find a health insurance is that you go to Healthcare.gov and enter your zip code while open enrollment is in process. You will be directed to the exchange in case it is present otherwise federal marketplace will be available for you. To buy the insurance plan you can either contact a private firm or can get it directly from insurer.

 

Compare the Types of Insurance Plans

You might see a set complicated alphabetical combinations that might confuse you while choosing for the right insurance plan. Common health plans include, POS, PPOs, HMOs and EPOs. Your choice of insurance plan will determine the benefits you will able to enjoy and what expenses you would have to pay out of your pocket.

Keep in mind to check the basic set of features of an insurance policy before buying it. There is a summary of benefits present with plan and the price is also mentioned with the title in an online marketplace. The hospitals and doctors covered by the particular health plan are also mentioned and the decision must be made accordingly. A benefits administrator in your workplace can provide you details of different insurance plans.

 

Choosing a Plan Based on Hospital Ward

You should never compromise on your health standards. So, you should see that the insurance plan you are choosing provides you A-plus service. If you don’t like to stay between lots of patients, you may choose 1 bedroom or double-A bedroom. If privacy is not an issue for you, you can use 4 bedroom B1 rooms or 8-9 C bedrooms. The more the privacy of the bedroom, the more is the cost and the more are the health insurance premiums satisfactory. Therefore, a good wardroom will provide you comfort but not everyone is able to afford such premium plans.

Upgrading from an A to B ward will cost several hundred dollars and may increase with the increase in your age. You need to make sure you get treated according to the plan you choose and it is up to your standards and the money you pay.

 

Choosing a Plan Based on Benefits and Medical Coverage

After choosing the type of wardroom, you must also compare the benefits and prices of the plans. In this way, you can estimate if your medical expenses will be covered in the money you pay and it will certainly help you in emergencies. The plans offer variations in annual payment, additional benefits, and post as well as pre-hospitalization expenses. The base coverage for all IPs is the same but they differ in packages.

For choosing plans based on benefits, look for annual limits first hand because these benefits provided depend upon their annual limit consumed in a year. Such as the annual limit for A wardroom is far more than the B wardroom and so are the benefits. Also, you should consider if you are covered in case of emergency by pre and post-hospitalization coverage. Psychiatric patients must choose plans with post-hospitalization services. Some IPs also give critical illness coverage so that you are covered if you suddenly suffer a stroke or a heart attack.

The stipulations a plan offers is also an important factor in choosing an IP. These riders provide a variety of benefits in long term. These stipulations include immediate family hospital accommodation, emergency outpatient coverage, coverage for post-hospitalization alternative treatment. They also usually cover 50% of the co-insurance and may even cover the annual deductible.

 

Choosing an IP Plan Based on Cost

The cost of IP plans is the most important factor because not enough money cannot provide you quality service and you may need to pay more or withdraw from the plan. If you are not diseased and don’t require a particular health plan, go for a low-cost plan. The cost increases with age and the standard of the wardroom. For example, if some plan costs 200 dollars for a 20-year-old, the same plan will cost 500 dollars for a 65-year-old. You can estimate if your plan is reasonable, you need to find out the plan’s total coverage per dollar of premium.

You need to make sure that you can afford the increment cost with the age of the plan you choose. If you have 200 dollars annually in your 20s, you should expect it to be $700 by the age of 40. . However, if you have A ward rooms, you need to pay from your pocket at an older age because it costs too much.

Considering all the above factors, you will get yourself a best health insurance at the end of the day. Compare best and worst health insurance companies and find the right one for you.

 

 

Member portal is unavailable, sorry for the inconvenience

Member Portal unavailable

The ClaimLinx member portal is no longer available. We are currently working to return this service to all of our members. We know how important it was to our members to have the portal, so we are very sorry for the inconvenience. The company that originally created the old member portal discontinued this service as of May 2020. The process to create a new portal with all the features members need is a long one. We are working hard to make sure members will have a portal to access in the future and that it will be better than ever.

Once the member portal is available, the ClaimLinx service team will contact company administrators to let them know how members will be able to access the site. We are very sorry the process of replacing the system has taken longer than expected.

What to do without the member portal

For now, members will have to contact our office to receive items or answers they used to get through the member portal. Start a conversation with a team member now by clicking the orange button in the bottom right corner of the website. Remember, our team is only available during regular business hours, that is Monday through Friday from 9 a.m. to 5 p.m. EST.

You may also email help@claimlinx.com and someone will get back to you as soon as possible. Call our office during regular business hours at (800) 858-1772. Using either of these options, you can request an update on a claim. You may also request a copy of any explanation of benefits for a previously processed claim.

Request Documents

For those that using the member portal in the past, you might miss downloading copies of commonly used forms and/or explanations of benefits (EOBs). You can always download copies of commonly used forms on the ClaimLinx website. You can request copies of specific EOBs from the Claims Department by sending an email to help@claimlinx.com, calling (800) 858-1772, or starting a chat conversation now. Start chatting with a representative by clicking the orange button in the bottom right corner of the website.

If you are used to downloading a regular claims usage report, you can make a request for this to be sent to your email on a regular basis. Contact the service team to make this request by sending an email to service@claimlinx.com. This is a temporary service we are providing to make up for the inconvenience of the missing portal. We appreciate your patience with this change.

Check on Claims

Members can check claim status at any time with the claims team by sending an email to help@claimlinx.com, calling (800) 858-1772, or starting a chat conversation now. Start chatting with a representative by clicking the orange button in the bottom right corner.

ClaimLinx processes claims within 10-15 business days of their receipt. Please keep in mind a claim can take between 15-90 days for it to be processed with insurance and then sent to ClaimLinx. For the best results, check that your primary insurance processed the claim before contacting ClaimLinx. See how to file a claim with ClaimLinx and how the claim is processed for more information.