On our previous blog, we discussed what exactly makes up a transparent health insurance plan and how this innovative model differs from the traditional broker-and-carrier model that most companies and employees are used to. One of the major benefits of a transparently managed health insurance plan is that it cuts costs for members in a wide variety of ways, yet still provides high-quality coverage and services to members. This is because the goal of a transparent health insurance plan isn’t to cut costs by removing common services and features of a traditional plan, but to simplify the structure of health insurance by removing opportunities for excessive fees and charges–and building a plan specific to each member group’s needs.
Here, we break down five major areas of savings employees will experience with a transparent health insurance plan.
Cost-Saver #1: No Network Means No Out-of-Network Penalties
How Does It Work?
A transparent health insurance plan usually opts for a different approach when it comes to working with vendors. Instead of spending time and resources to negotiate a network of providers, like in a Preferred Provider Organization (PPO), members of a transparent plan have open access across healthcare providers. This means they can see virtually anybody they’d like, they just need to nominate their provider to participate.
How Does It Save Me Money?
Without a preapproved network of medical providers, you never have to worry about paying an out-of-network penalty on top of your other insurance expenses. Also, since your health insurance isn’t trying to make money by creating their own special network and needing to pay specific rates to people within their network, these costs are not passed along to you as a member.
Cost-Saver #2: Preset Deductibles and Preset Out-of-Pocket Limits
How Does It Work?
The top priority of a transparent health insurance plan is total cost transparency for members. This includes providing certain freedoms to the member groups you wouldn’t find in a traditional model. Instead of creating a plan for your group and assigning a cost to the deductibles and out-of-pocket limits, a transparent plan allows employers to set the overall deductible amount themselves and to set out-of-pocket limits on member expenses.
How Does It Save Me Money?
At ClearChain Health, one of the top frustrations we see from member groups transitioning out of a traditional carrier model is they don’t understand the pricing structure of their benefits, or even what they’re paying for. By allowing the employer to consider the financial health of their employees and create their own deductible and out-of-pocket limits, employees can better budget their healthcare expenses–and may even see some money go back into their paycheck. Some of our member groups save up to 10% on employee contributions to their insurance.
Cost-Saver #3: Convenient and Unique Features for You as a Member
How Does It Work?
When you save money in certain areas of your plan, this frees you up to apply these monies to other areas. For example, if you’re saving 30% after switching from a traditional broker, that money saved can be reinvested into a special feature or benefit for your employees’ unique needs. A transparent health insurance plan will often work with you to determine where this money should go.
How Does It Save Me Money?
Not only will you pay less in your plan, but imagine how, if reinvested in a way that suits your lifestyle, the additional savings could help you out. At ClearChain Health, our member groups enjoy zero-dollar doctor’s office visits for children thanks to saved money.
Cost-Saver #4: Zero-Dollar Refills on Generic Prescriptions
How Does It Work?
Are you paying too much for your prescription medications? Switching from a name-brand to a generic prescription may be a good choice for you. In a traditional health benefits plan, the broker will often work behind the scenes with a pharmacy benefit manager to negotiate the costs of name-brand prescriptions. This includes working with pharmaceutical companies for discounts and rebates for prescriptions–which usually benefit the broker or the benefit manager.
How Does It Save Me Money?
With a transparent health insurance plan, these opportunities for rebates and discounts are eliminated by focusing on generic prescriptions as opposed to the name brand. Similar to removing a provider network, making money on the back end no longer is a priority. Your transparent health insurance provider can offer these generic drug options at no cost to you.
Cost-Saver #5: See Your Claims Clearly and in Detail
How Does It Work?
Transparent health insurance management includes auditing each claim submitted. Your health insurance company will keep your best interests in mind, so they’ll be looking closely for any fraudulent, erroneous charges on your bills. For example, if a hospital billing department decides to unbundle a CPT code , your insurance will catch this and get it rectified before passing the bill along to you.
How Does It Save Me Money?
Auditing claims helps catch excessive charges and price gouging before you even see your bill. Since your health insurance catches these charges for you, they aren’t passed along to you in the billing process.
Ready for Better Benefits and Better Health Insurance Savings?
At ClearChain Health, we believe in a direct relationship between you, your health insurance and your medical provider. This provides total transparency in your billing, lowers your out-of-pocket costs and eliminates the outdated, restrictive PPO network model. Learn more about our model and contact us today!