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CHC Self-Funded Health Plan



 
At CPG we are proud to offer our partially self-funded health plan which is changing the way community health centers approach their employee health benefits.  


Introduction



Providing good health insurance benefits for your employees is essential to recruiting and retaining a high quality workforce.  But health benefits are also expensive —and often uncontrollable, with premium increases unrelated to your group experience—and difficult to manage.  CommonWealth Purchasing Group (CPG), along with our vendor partners,  now offers a health insurance plan that provides the same (or better!) plan coverage, saves money, and reduces your plan management time.

The CHC Self-Funded Health Plan is a partially self-funded plan, combining the advantages of a fully-insured program (a fixed cap on health center costs) and a self-funded approach (if medical claims do not exceed the budgeted total, the center keeps the difference.)  Using both individual and aggregate stop loss insurance, the maximum annual cost is determined in advance; the health center will never pay more than the contractual maximum.  But if medical expenses are less than expected the health center —not the insurance company— saves 100% of the difference.


How It Works


In a fully-insured plan you pay a fixed monthly premium, regardless of your claims.  The CHC Self-Funded Health Plan breaks this charge into three categories —administrative costs, stop loss insurance costs, and medical claims.   The administrative and stop loss insurance costs are fixed; the claims costs are a budget projection.  If the claims cost exceeds the budgeted amount the stop loss insurance pays 100% of the additional costs.  If, however, the claims costs are less than
the budgeted amount the health center saves 100% of the difference.

An actuarial study of five community health centers —some large (up to 450 covered employees/families), some small (as few as 52 covered employees/families); some in urban areas, some not—  showed significant savings using the CHC Self-Funded Health Plan when compared with current coverage.  Based on identical plan designs, the expected savings ranged from 6% to over 30%!


Our Partners


CommonWealth Purchasing Group has partnered with an outstanding set of industry-leading firms to develop and operate the CHC Self-Funded Health Plan:  

  • John Siracusa of Group Brokerage Insurance Agency & Digital Benefits has been working with community health centers for more than 20 years and is thoroughly familiar with the needs and challenges of our members.  John is the day-to-day contact for all aspects of the plan. 


  • American National Insurance Company, an A+ rated carrier, provides the stop loss insurance that protects health centers against catastrophic claims and higher than expected utilization.


  • The designated third party administrator (TPA) for the CHC Self-Funded Health Plan is Health Plans, Inc., a wholly-owned subsidiary of Harvard Pilgrim Healthcare, Boston, MA.  Health Plans is the largest and most sophisticated TPA in New England and ranks among the best in the nation in terms of customer service, systems technology, reporting, claims and account management, and claims adjudication. As part of Harvard Pilgrim Healthcare, Health Plans. Inc. has access to the Harvard Pilgrim Preferred Provider Organization (PPO.)   The Harvard Pilgrim PPO contracts with the leading hospitals, physician groups, and other providers throughout most of New England.  In other parts of the country, the CHC Self-Funded Health Plan will offer similar highest quality healthcare provider networks to our members.

 

Customized to Meet Your Needs


Several elements in the CHC Self-Funded Health Plan can be tailored to fit the specific needs of our members. Though our analysis will initially be based off of an identical plan design, if you want to make modifications to your existing plan (changing copays or deductibles, adding or deleting certain services, etc.) you can.  We can also modify the provider network, adding or removing providers (for example, adding your health center if it is not included in the Health Plans network.)   Finally, there are two payment options: (1) Pay a fixed monthly fee based on the contractual maximum annual cost and claim a refund of 100% of the difference between the maximum and actual costs. Or, (2) Pay a fixed monthly fee for administrative and stop loss insurance costs and pay medical claims as they are presented. In the latter case there would be no end-of-year refund, but rather your organization retains the unspent plan funds throughout the year. 

 

Assuring the Highest Level of Member Services


Employee health insurance is expensive, complex, and highly technical. To assure that all CPG members participating in the plan receive independent expert analysis of their health benefits program on a regular basis, we have contracted with an employee benefits cod nsulting firm to provide an independent  comprehensive review of plan design, costs, and experience for each health center. The cost of this service is built into the administrative fee and there is no additional charge to the member.      



For more information on how to get started:


We are eager to visit at your health center an ive you a formal presentation on the plan! If you are interested in learning more, or have any questions, please contact:


Rick Bryant, Director
CommonWealth Purchasing Group, LLC

Phone:
617-988-2250
Email: rbryant@cwpurchasing.com


Or


John F. Siracusa, CFP
Group Brokerage Insurance Agency

Phone: 617-491-0050 ext. 102

Email: john@groupbrokerageins.com








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