ClaimLinx Health Insurance Strategy

ClaimLinx Offers a Full-Service Insurance Strategy

ClaimLinx offers more than just a way to provide health insurance to your employees. We offer a holistic solution to give great benefits to employees while saving money for business owners. Our ClaimLinx Solution blends a high-deductible insurance plan with a company-funded medical expense reimbursement plan (MERP). The result is an optimized health insurance plan for everyone at your business. ClaimLinx explains how we make this full-service insurance strategy work in today’s blog.

High-Deductible Health Plan

A high-deductible health plan allows for lower monthly premiums. Lower premiums mean you pay less money to have the health insurance plan in place. Normally, higher deductibles mean employees must pay more money before insurance coverage begins to pay for medical expenses. But ClaimLinx has a different strategy.

In 2019, the IRS defined a high-deductible plan as one with at least $1,350 for an individual or $2,700 for a family. These minimums mean individuals must pay the first $1,350 of medical expenses before the health insurance plan starts to cover certain costs. But ClaimLinx typically chooses plans with deductibles much even higher to really slash expenses on premiums. This is a part of our full-service insurance strategy.

Related Post: What is an employer-sponsored, or self-funded, plan?

MERP

Employers can use a MERP to help fund an employee’s costs before reaching his or her deductible. When paired with a high-deductible plan, MERPs offer a health insurance strategy that is cost-effective for employees and employers. 

For example, John Smith goes to the emergency room for a minor injury and receives a bill for $2,500. His insurance carrier sends him an Explanation of Benefits (EOB) that says he owes the full amount because he has not yet met his high deductible of $3,500. John’s employer, Acme Brick, has a MERP that covers emergency room visits with a $350 copay. That means John only pays $350 instead of $2,500. 

The ClaimLinx Solution is a win for everyone. John Smith experiences lower costs for medical expenses. Also, John’s employer is happy because he can afford to offer such great benefits since the cost of the company’s monthly premiums has gone down so much. Our full-service insurance strategy identifies the optimal combination of high deductible plan and MERP.

Related Post: What Is a MERP?

How This Strategy Saves Money

A high-deductible health plan lowers the monthly premiums for each employer. Instead of paying $1,000 per month for a family’s coverage, an employer might pay $700. A MERP continues the savings because it’s a tax deduction. Every time an employer reimburses an employee’s medical expenses, it lowers the amount of money the IRS figures into business taxes. Business owners not only pay lower income taxes, but they also lower onboarding costs by retaining employees for longer periods of time. Employees who remain healthier are more productive and miss less work. ClaimLinx shows you how we deliver for both business owners and employees with our full-service insurance strategy.

The ClaimLinx Solution: A Full-Service Insurance Strategy

ClaimLinx is here to find the best possible solution for health insurance at your business. We educate business owners and employees on the best practices for combining health insurance plans with a MERP. Our team provides third-party administration, employer benefits consulting, and complimentary elite services to our clients. Contact ClaimLinx or call toll-free 1-800-858-1772 for more details about our full-service insurance strategy.

We are the full service insurance benefit solution

When it comes to a true health benefit solution, the work doesn’t stop with simply changing insurance carriers or establishing a new plan. Employees understanding how to use the plan and employers seeing the differences in coverage and cost are just as vital throughout the year as they are on day one.

That’s why it’s a priority for our team to provide the following elite services for all of our clients:

  • In-person or online education meetings
  • Claims reporting and analysis
  • Consulting for prescription drug use
  • Medical claim negotiation
  • Prescription drug rebate checks
  • Online enrollment for easy renewal
  • Adjustments to the schedule of benefits

Education is one of the highest priorities at ClaimLinx. We believe employees who are more informed about insurance become better health care consumers overall. That means they are better able to use the health plan and are getting more out of it. So we offer to all of our clients for a service team member to come to the company for an education meeting at any time.

Related Post: What is an employer-sponsored, or self-funded, plan?

We find education meetings to be the best way for employees to hear how their new plan works and what changes they can expect. Meetings can be done on location or online as a webinar.

Throughout the year we also focus on finding more ways to save money on the health plan. Cutting initial premium costs can often be just the beginning. We take a look at the company’s actual claims data to see where adjustments can be made to improve savings. Sometimes this means making an adjustment to the schedule of benefits, moving an employee to a better plan, applying for a prescription drug discount card, or other savings strategies.

Related Post: Why Insurance Rates Are So High and How to Start Cutting Them

But it doesn’t stop there. To help maintain costs on claims, we partner with a medical bill negotiator to ensure all high dollar claims are being charged correctly and employers are paying the lowest cost possible. This is an included service with ClaimLinx as the third-party administrator for the plan.

These continuous consulting and additional plan services that contribute to savings are only offered at ClaimLinx. Our experts are focused on constantly improving the plan for employees while ensuring the costs remain low.

 

State of the Union Spotlights Pharmaceutical Problem in America

Pharmaceutical companies’ stocks took a hit just after the State of the Union address, when President Trump listed drug pricing as one of his “greatest priorities” this year.  Medication prices across the board have been rising sharply, occasionally with consequences from Washington.

For example, Turing Pharmaceuticals former CEO Martin Shkreli was called to appear before Congress when he raised the price of the AIDs medication Daraprim from $13.50 per pill to $750 per pill in 2016.

Related Post: Drugmakers Pfizer and Allergan Merge for Tax Break

There have not yet been any policy initiatives to force drug prices down, and until there are, prices are likely to continue to rise — with insurance companies finding more ways to pass this burden onto you, the consumer.

One of biggest changes I’ve seen among my own clients is many medications have changed tiers, resulting in a much higher cost share for members.  So a drug that was once in Tier 2 and covered with a $50 copay may now have switched to Tier 3 with a $150 copay — for the same drug at the same insurance carrier. That’s a pretty shocking price hike in a matter of just a few months.

I’ve also seen many insurance carriers adopt a Mandatory Generic Substitution for a growing number of medications. This requires members only receive the generic version of a drug, or pay the difference for the brand name version.

Related Post: Drug Coverage Changes With Continued Spending Hike

Then some drugs have fallen off of insurance carriers’ formularies altogether, meaning they are no longer covered at all.  Most often this happens when a drug has become so expensive even insurance carriers are having trouble paying for them. So imagine how the average consumer feels.

All in all, this is not a problem exclusive to 2018 alone, but it is a problem that will only get worse until sweeping changes are made to how drugs are priced. So please, Mr. President, make the drug industry great again.

An insurance shakeup? Three American corporations join forces to tackle healthcare

Amazon CEO Jeff Bezos, Berkshire Hathaway CEO Warren Buffett and JP Morgan CEO Jamie Dimon are joining forces to launch their own healthcare company, according to a press release today on Business Wire.

The goal of their new joint venture “is to create solutions that benefit our U.S. employees, their families and, potentially, all Americans,” said Bezos.

But what does that mean for everyone else in the health insurance industry?

Related Post: Drugmakers Pfizer and Allergan Merge for Tax Break

Right now — nothing. Aside from a quick, and might I add pretty painful, hit to stock prices of insurance carriers like Cigna, Aetna and UnitedHealth, there won’t be any immediate repercussions.

What can be speculated though is that these three enormous companies will make potentially huge waves as they pull employees off current major carriers’ services. Depleting members reduces the pool of money that insurance carriers will have for their own claims and administration. If the majority of those leaving are young, healthy people, some Americans could see an increase in costs for their insurance plan — on top of already rising prices in the industry overall.

On a more positive note, new enthusiasm and innovation might just be what the industry needs. Having new blood in an incredibly old, often entrenched system might spur creative strategies to encourage savings. Major carriers across the country will have to do something to shore up for the changes this new company could bring.

Related Post: Why Insurance Rates Are So High and How to Start Cutting Them

Ultimately employees of the three companies will benefit first as the new healthcare company will be staged to take care of just them as a starting point. If Bezos statement rings true after this initial step, it may benefit “potentially, all Americans” by providing healthy competition into an ever-shrinking market.

Changes to Our Phone Operating System

Last week ClaimLinx conducted a trial of a change to our customer service phone operator from a local attendant to an auto attendant. We believe this transition will ensure members and administrators will reach their desired departments faster, and with less front-end explanation. 

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

This change will remain permanent for the foreseeable future. We have already seen an improvement in our call efficiency. We have found members are able to reach the claims department quickly, without having to explain their issue to multiple people.

Below are the options all callers hear when reaching the general ClaimLinx customer service numbers, (800) 858-1772 or (513) 677-6262.

  • Dial 1 – If you are a member or provider’s office calling about claim status, benefits or eligibility
  • Dial 2 – If you are an administrator or broker
  • Dial 3 – If you are in need of insurance
  • Dial 4 – Lisa Grubb, ClaimLinx Health Insurance agent
  • Dial 5 – Kathy Durnell, ClaimLinx Health Insurance agent
  • Dial 6 – To reach accounts receivable
  • Dial 7 – General mailbox

Related Post: ClaimLinx Has Made Staffing Changes to Better Serve Clients

Administrators and members can still reach specific ClaimLinx team members by dialing their extensions or their direct lines.