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.


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