An A (Excellent) rated carrier insures a small group health product in Texas that is administered by an out-of-state TPA. Employers are given an option of six (6) PPO networks to choose from. There is a premium factor assigned to each network, persumably based on the “discounts” in place.
One would assume that the carrier has access to each PPO’s contracted rates with providers and therefore can document which network has the deepest “discounts” and which do not. However, we dont know that for sure. But if it is true, then one could conclude that some PPO networks have negotiated better deals on behalf of their clients than others. This adds credance to those sales pitches we hear from agents, brokers, carrier reps. and consultants.
The problem with all of this is that we have no documentation to support this conclusion. However, what we do have is the PPO rate factors published by this carrier for their Texas small group block of business:
Discount off Manual Health Rates
HealthSmart -10%
IMS -7%
Texas True Choice -10%
Beech Street +2% Premium Load
Interplan -4%
PHCS -5%
This TPA is charging a $6 pepm PPO access fee, irregardless of which network is selected.
