This health plan is an expense account funded by your employer.
“When you go out of town on company business and have to stay overnight we will pay for your hotel room. The expense account limit is $150 per night so if you decide to stay at the Ritz Gold Star Hotel you will have to pay the difference” explains Sally in accounting.
“The same holds true for your medical expenses. For example, our plan pays $17,000 for a hip replacement. Anything over that is your responsibility. Before you receive health care you will know up front exactly how much you will be required to pay. And if you’re smart and use our concierge service you will owe nothing! No deductible, no coinsurance, no copays, no balance bills, no nothing!”
The 100% Plan incorporates transparent pricing. It avoids certain federal mandates which largely eliminates risk of punishing government sanctions.
The plan puts the consumer in charge of their healthcare needs. Members decide where they go for care and how much they are willing to pay for care. They know they may be responsible for balance billing amounts above plan payment amounts.
They know medical caregivers will compete for business. And they know there will never be a balance bill if they ask the price prior to receiving covered services.
This plan structure will produce premium rates well below traditional managed care plans. Medical trend will be virtually eliminated resulting in multi-year static rating.
This plan is not new. It was implemented last year for a +3,000 employee group located in multiple states. Plan members love their 100% Plan and will never go back to the failed plans of the past.
THE FOLLOWING IS SUGGESTED LANGUAGE TO BE PROMINENTLY DISPLAYED ON MEMBER’S HEALTH INSURANCE CARD:
This is a non-traditional health plan. The plan does not use a network. Medical providers are paid based on current Medicare reimbursement rates. There is no member cost sharing other than amounts that may be charged above Medicare rates. The No Surprises Act (NSA) / Independent Dispute Resolution (IDR) does not apply to this plan.
Benefit Summary
No Co-Pay
No Co-Insurance
Covered Eligible Medical Expenses – 100% of Allowed Amount
Rx Benefit: All FDA approved prescriptions included in the World Health Organization’s (WHO) Essential Medicines List are covered. The plan reimburses the member and does not accept Assignment of Benefits. Reimbursement amount based on lowest retail cash price within a 25 mile radius of member’s chosen retail pharmacy.
Notice To All Providers: Member may request a Predetermination of Charges at the point of service. All charges exceeding Medicare reimbursement rates are the responsibility of the member.
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.
