Special Edition
May 8, 2014
  
Differences Affect Your Workflow 
Fully- vs. Self-Insured Members 
  
Whether filing claims, looking for the proper website, notifying us prior to an admission, or calling Member Services, you need to know how to make the right connections for fully-insured versus self-insured members.
  
Overview: Fully-vs. Self-Insured
CoOportunity Health is a licensed health insurer in both Iowa and Nebraska. We contract with HealthPartners Administrators, Inc. (HPAI):
  • To provide back-office enrollment, claims processing, medical management, and certain other administrative services for fully-insured customers.
  • To serve as a direct benefit services (or third party) administrator for cobranded self-insured employer sponsored health plans in both states.
Both fully- and self-insured business utilize the Midlands Choice network.
  
So what are the differences you might see between fully-insured and self-insured plans, and how do those differences affect the way you do business with us?
  
ID Cards
One of the more obvious differences is the identification card, which are unique because of funding arrangement differences. Use the ID card to identify appropriate resources for each patient.
  • For fully-insured business:
    • The ID card is branded with the CoOportunity Health logo.
    • HealthPartners Administrators, Inc. is listed on the back of the ID card as the administrative services provider.
    • The notation "Plan" identifies the CoOportunity Health product name. Our fully-insured product names are named Premier, Choice, Preferred, and Iowa Marketplace Choice Plan.
    • The national "wrap" network used for CoOportunity Health is MultiPlan and PHCS.
  • For self-insured business:
    • The ID card is cobranded with HealthPartners Administrators, Inc. and CoOportunity Health logos.
    • Because the employer is the plan sponsor/insurer, it contracts directly with HealthPartners. The employer's logo may also display prominently on the ID card.
    • HealthPartners Administrators, Inc. is always listed on the back of the ID card as the administrator.
    • The notation "Care Type" identifies the product name. The employer may select a custom product name, and could use a custom network.
    • The national "wrap" network used for self-insured business is Cigna.
Note: Sample ID cards follow. These are samples only; as noted above, variations exist.
  
FULLY-INSURED PLANS - Underwritten by CoOportunity Health and Administered by HealthPartners
  
              Sample of a Fully-Insured ID Card Front                           Sample of a Fully-Insured ID Card Back   
 
SELF-INSURED PLANS - Employer-Sponsored Health Plan Administered by HealthPartners and Cobranded with CoOportunity Health
    
                
                Sample of Self-Insured ID Card Front                                Sample of Self-Insured ID Card Back  
 
 

Three Self-Insured Plans
  
To identify a member of a self-insured plan, use a group number on the ID card. As new self-insured plans are added, we will update this table on our Plan Resources website page (see Self-Insured tab).
  
 
  
Web Resources
For more information about fully- and self-insured differences, review our
Differences Affect Your Workflow fact sheet. The fact sheet includes a question and answer segment and URLs/Links to commonly accessed information for both fully- and self-insured members.