Healthcare costs keep rising. Employers need smart ways to control expenses without cutting coverage quality.
That’s why ClaimLinx’s Simple Option Solution works so well for small businesses. It pairs a traditional major medical plan with a company-funded Medical Expense Reimbursement Plan (MERP) as a secondary benefit.
A MERP gives your benefits plan flexibility as your needs change.
A MERP lets employers pay employees’ medical costs based on a set Schedule of Benefits (SOB). Each plan fits the company’s needs and budget. It can include standard cost-sharing tools like deductibles, coinsurance, and copays. MERPs can lower your company’s overall health insurance costs. Instead of paying a high monthly premium for coverage employees may not fully use, you only pay for medical expenses that actually occur.
Skip the one-size-fits-all policy. ClaimLinx tailors the plan to your company, sets it up, and handles claims processing. We pay providers directly for medical services after any primary carrier payment or discount. A MERP gives members quality benefits without the high cost of a major medical carrier. It’s also flexible, so employers can offer benefits in many different ways.
Clients using the Simple Option Solution can expand benefits for employees enrolled on a spouse’s plan by adding a Spousal MERP. When a company adds a Spousal MERP, the employee’s spouse’s major medical plan becomes the primary coverage.
The MERP then becomes the secondary plan, adding the extra benefits. Employees get the same cost-sharing benefits as everyone else, but the plan costs the company less since it doesn’t cover the full primary insurance premium. To encourage employees to use the Spousal MERP, ClaimLinx recommends employers reimburse part of the member’s premium cost, just like they would for a primary plan.
A Spousal MERP is a great way to add benefits for employees at a lower cost.
Many Medicare-eligible employees find the switch to an unfamiliar plan difficult. Adding a dedicated MERP helps these employees move to Medicare comfortably. For these members, Medicare becomes the primary plan, replacing the major medical carrier. This cuts premium costs for the company.
Medicare often offers better benefits than a high-deductible plan from a traditional insurer. Adding a MERP lets these employees keep enjoying the same great benefits after they switch. Employers benefit immediately too: the company stops paying a monthly premium and takes on less liability for its health insurance plan.
ClaimLinx advises clients and members to confirm a provider or facility is in-network on the primary plan before receiving services. The secondary ClaimLinx plan always follows the major medical policy. If the primary insurance denies a claim, the secondary plan denies it too — for any provider or service.
Still, some members can’t avoid these charges. In these cases, we recommend adding an out-of-network MERP. This separate schedule of benefits outlines its own coverage. It may cover only certain services and includes a set plan limit.
An out-of-network MERP helps members handle unforeseen costs without driving up overall plan costs. Some employers choose to offer this as an added benefit. The ClaimLinx Solution saves the company money, freeing up budget for extras like an out-of-network plan.
The best part of the ClaimLinx Solution? You can tailor the plan to fit your company’s exact needs. Adding more MERP options benefits employees and cuts costs.
Talk to the Service Team or your benefit consultant today to learn how to enhance your company’s benefit offerings.
Change is never one-size-fits-all, and we’re committed to making this transition as easy as possible. If you have questions about the update, need help logging into your portal, or want assistance reviewing a claim, our Member Services team is ready to help.
You can reach us at (800) 858-1772 or by email at claims@claimlinx.com.
Thank you for choosing ClaimLinx. We appreciate your continued trust in our team as we work to make your benefits experience clearer, faster, and more convenient.
At ClaimLinx, we’re committed to providing our members and providers with the best possible service. Moving EOBs to the online portal is just one way we’re making claims processing more efficient, secure, and environmentally responsible.
