Self-funded? Curious about how much it costs to pay a claim?
To find out you have to ferret out all the fixed costs. Be aware, some are hidden on the claim side of the ledger.
You may be surprised to find your fixed costs are every bit of, or close to, $200 pepm. If it’s less look again on the claim side of the ledger because chances are high you missed something.
With that in mind let’s assume:
- Your fixed costs are $200 pepm.
- You’re financing $500 towards the employee only rate and $1,500 for employee + dependents.
- Dependent participation is 12%.
- There are 100 employees.
- Total monthly premium is $62,000 (based on the contribution levels stated above)
Fixed costs take up 32% of plan contributions before any claims are paid. One third of plan cost does not go directly to pay claims, instead vanishing into the swirling black hole of the Great American Healthcare Industrial Complex benefiting third party intermediaries.
Bypassing as many of these third party intermediaries as possible reduces the cost of paying claims. Cash transactions = Net Zero.
Moving to the other side of the ledger, do you have any idea how much your claims are inflated over cost? That information is readily available if you know where to look. You may be surprised to find your claims are inflated 200-1,000% over cost.
There are remedies to that.
Total plan costs can be reduced 50% or more if you know how.
Business is about solving other people’s problems. Solving the high cost of healthcare giving employers a competitive advantage is ours.
Status quo convergent thinking solves problems through a very narrow lens. Divergent thinking empowers us to solve problems with a wide lens allowing us to see what others don’t. You can’t fix what you don’t see. You don’t know what you don’t know. We see opportunities others miss. We do what others don’t. Winning together is our goal.
RiskManagers.us is a specialty company in the benefits market that, while not an insurance company, works directly with health entities, medical providers, and businesses to identify and develop cost effective benefits packages, emphasizing transparency and fairness in direct reimbursement compensation methods.
The shared vision of RiskManagers.us and clients who retain our services is to establish and maintain a comprehensive employee health and welfare plan, identify cost areas that may be improved without cost shifting to any significant degree, and ensure a superior and sustained partnership with a claim administrator responsive to members needs on a level consistent with prudent business practices.
Plan costs, in all areas including fixed expenses and claims are open for review on a continuing basis. Cost effective plan administration and equitable benefit payment to providers are paramount to fulfilling our mutual fiduciary duties.
As we proactively monitor and manage an entire benefit program we are open to any suggestions members may make or the dynamic health benefit market may warrant in order to accomplish these goals. Duty of loyalty to our clients, transparency and accountability are essential to the foundation of our services. To that end, we expect our clients to realize a substantial savings based upon the services that we will deliver.
