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.