Employers
Thinking of switching to self-funded plans? At Concierge, we’re here to help you every step of the way. We always strive to provide excellent service, real savings, and a top-of-the-line experience for everyone on your team.
Our Commitment to Savings & Service
With fully insured plans, employers often pay much more than they need to while still missing out on the services their team members need. When you self-fund, you’re only paying for what you need. Plus, you can pocket the difference!
So, why partner with Concierge? Because we don’t just stop at excellent savings. We go the extra mile to provide excellent service, too.
Self-Funded vs Fully Insured
It’s no secret that insurance is needlessly complicated, but our goal at Concierge is to simplify and save. Our self-funded plans allow companies to save what they don’t spend, while insurance companies pocket savings on a fully insured plan.
SELF-FUNDED
Lower fixed costs
Lower yearly premium increases
No state premium taxes
Variable claims costs
Variable savings
FULLY
Higher fixed costs
Higher yearly premium increases
Must pay state premium taxes
Fixed claims costs
No savings
Self-Funded Misconceptions
WHAT ABOUT THE FINANCIAL RISK?
Many employers fear the ‘financial risk’ associated with self-funded benefit plans. Depending on your group, a few or even one high-cost claim could potentially jeopardize an organization, unless you’re partnered with the right TPA! Good thing we’re here, right?
BENEFITS OF Stop-Loss Coverage
To avoid catastrophic costs associated with one or multiple expensive group claims, employers can invest in stop-loss coverage, which insures they won’t have to pay out medical expenses past a certain threshold. Think of it as a ‘protection plan’ for your group.
WHAT ABOUT SPECIALTY MEDICATION NEEDS?
The rising cost of specialty medications is a major concern for many employers—but it doesn’t have to be! We’re all about delivering top-notch service, and that means we’re focused on giving employers alternative funding options,. This includes supplemental stop-loss coverage to reduce risk and the cost of specialty claims.
Solution—Self-Funding
By opting out of a fully insured plan, employers can work with a TPA to develop a benefits plan that’s specifically tailored to the needs of their employees. Plus, employers and TPAs can foster a much closer working relationship than possible with larger, traditional insurance companies.
Fully Insured Pitfalls
Problem—No Flexibility or Service
A critical downside of choosing fully insured coverage is that employers get little say in which benefits or kinds of coverage they want for their group. This leaves very little opportunity for flexibility, customization, or for providers and employers to work closely together. As a result, employers overpay for services they may not need, and employees may fail to receive ideal benefits.
Solution—Self-Funding
By opting out of a fully insured plan, employers can work with a TPA to develop a benefits plan that’s specifically tailored to the needs of their employees. Plus, employers and TPAs can foster a much closer working relationship than possible with larger, traditional insurance companies.
Problem—High Costs
Fully insured coverage tends to cost more for the same or fewer benefits because insurance providers profit from employers overspending on their health plan. Not all of that ‘fixed cost’ is going to towards your employees’ premiums.
Solution—Self-Funding
On the other hand, whatever employers put into their health plan but don’t spend on claims, they get back at the end of the year (other fees aside). This makes self-funding a more affordable option for employers and employees alike. You reap the benefits in below average claim years, and you’re protected by stop-loss coverage in above-average claim years.
Still not sure whether self-funding is best for you? Check out our resources or give us a call—we’re happy to answer any questions you have.
Keeping Your Coverage Compliant
Concierge works with partners WLT and TALON to provide MediConnX 360, which ensure that your coverage adheres to the No Surprises Act (NSA), the Consolidated Appropriations Act (CAA), and the Transparency in Coverage (TiC) Rule.
By using the MediConnx360 portal, employees can shop for lower cost care (which reduces claims costs) and plans remain compliant with state and federal legislation. Other benefits include:
- On-demand access to machine-readable files (MRFs)
- A price comparison tool to shop for lower cost care
- Ability to verify claim payments
- And more!
“We have used Concierge Benefit Services as our dedicated Third-Party Administrator (TPA) for almost ten years. Their unwavering commitment to delivering exceptional customer service and unparalleled industry expertise has been evident throughout our partnership. Their profound understanding of the field distinguishes them from other TPAs, and their unwavering dedication to providing outstanding service is truly…
– Brett, Client Partner
“Concierge is a highly proficient TPA that provides the customer service that is so often lacking in the group benefit industry. I can proudly recommend Concierge to my clients as a long-term partner that will accommodate their needs while providing a terrific member experience.”
– Chase, Broker Partner
“WLT has had the pleasure of serving the software and services needs of Concierge and their staff for many years. It is truly a pleasure to work with their teams as they are focused on giving their clients the absolute best service experience in the industry.”
– Jeannette, WLT, Vendor Partner
Employer FAQs
A formulary is a list of drugs covered by your health plan. They vary by plan and are often referred to as a preferred drug list (PDL).
Please contact your dedicated account manager to discuss any necessary changes to your plan.
There are a few reasons why a claim can be denied, but each case is different. If you have a question about a specific claim, contact your dedicated account manager or give us a call at 888.820.5687.
PBM stands for pharmacy benefit manager. The role of PBMs is to provide employers with discounts on costly specialty and non-specialty drugs, or to recommend more affordable alternatives to medications.
Think of stop-loss coverage as a ‘protection plan’ for your group. It helps avoid catastrophic costs associated with one or multiple expensive group claims. With stop-loss coverage, employers don’t have to pay out medical expenses past a certain threshold.
Let’s Talk About Your Savings
Ready to strengthen your bottom line and receive excellent service with Concierge?