| Issue: # 20 |
August 21, 2008 |
Greetings!
Keeping you informed of the latest developments in the employee benefit marketplace.
If you have any questions, e-mail Bill or Vanessa. To learn more about Advantage Benefits, click here. Many of our clients have found these newsletters to be quite helpful and we have now set up a link to hold all the archived newsletters on-line that can be accessed at anytime.
If you know anyone, who may find this information of interest, please forward them this newsletter (there is a link on the bottom), and they can subscribe themselves.
Sincerely,
Bill Randell, CLU, CHFC Vanessa Costa, CLU,CHFC
Advantage Benefits Group, Inc. |
| Fully Insured Versus Self-Funding
Take a Closer Look |
Most small businesses in Massachusetts offer a fully insured group health plan. Primary carriers are Blue Cross, Tufts, Harvard & Fallon. Basically, a monthly premium is paid and the insurance carrier pays all claims per the actual policy provisions.
Most groups have no idea how much the carriers plays out in claims on their behalf. The insurance carriers are not required to furnish that information for groups less than 100 employees. So, each year business owners are at the mercy of the carriers and go through the exercise of getting quotes and increasing co-payments or contributions from employees.
Self Insured Plans have been around a long time. Traditionally, they were used by companies with hundreds of employees. As fully insured plans continue to escalate, the self insured plans are worth taking a closer look.
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Pill Splitting
Split Incentive Program
This is fascinating information and we would be curious to know how many of you are familiar with this. The Federal Drug Administration has approved over 500 drugs that are eligible for "pill splitting", an innovative cost savings program.
Expensive brand name drugs represent the largest expense in any prescription plan. These drugs are often available in many strengths. Dramatic savings occur when tablets equal to twice the prescribed dose are supplied and half of the tablet is taken. The correct dose is taken by the patient, but the actual prescription comes with a FREE PILL CUTTER to be used by the patient.
Check out the list of commonly prescribed drugs that may take advantage of the split incentive program. Here are just a few of them: LIPITOR,, VIOXX, ZOCOR, CRESTOR, GLUCOVANCE NORVASC and ESTADIOL. There are others, but the "spam" filter prevents us from listing here.
The self insurance program that we are now using will offer your employees a ZERO DOLLAR CO-PAYMENT FOR A 90 DAY SUPPLY OF THESE DRUGS.
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Pharmacy Benefit Managers
PBM's |
Some of you may be familiar with Express Scripts which is one of the largest PBM's and is widely used by the insurance carriers. There are many other PBM's and some are very aggressive in their process to manage & maintain drug selections, utilization, pricing and cost containment measures.
For those of you who already may have a full or partial self insured plan, you should get to know who is the PBM of your plan and ask questions, especially if pill splitting is an option.
Not all self insured plans are created equal. This example of pill splitting is just one way a self insured plan may reduce overall health costs. If you are in an industry where typically claims run high - like Social Services, then you can still benefit. Here are some general advantages of self funding:
- Cash Flow Benefits
- Control / Customization of Plan Design
- Savings from Premium Taxes
- NO "Gatekeepers" (HMO) to the underlying health plan
- Cost & Utilization Controls
- Reduces COBRA and other administrative headaches
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Advantage Benefits Group is a closely held business just like many of our clients. We run into the same headaches & problems that you have everyday. Our expertise is group health, life and disability insurance. We initiated these email newsletters earlier this year to share ideas and items that we hope you have found of interest. We want to be a resource for your business. Anyone can get rates, that is the easy part, we want to be a partner to help you with all aspects of employee benefits.
Please send us an email and let us know what you think, or let us know a particular topic you would like us to address. For those of you who have sent us email comments, we thank you and appreciate your business.
Don't forget, like you, we are always looking for new businesses to work with. If you know another business owner who is frustrated with their health insurance and needs help, your referrals would be greatly appreciated.
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