UNIQUE NEEDS DESERVE
PERSONALIZED SOLUTIONS

Self-Funded Group Medical Plans

With the assistance of HCS, you can purchase stop-loss or excess risk insurance to protect against catastrophic claims. This allows the freedom and flexibility necessary to design a plan to meet your specific needs.

HCS excels in analyzing current benefits to help identify and address better solutions for both the employer and the employee. HCS’s preferred status with many stop-loss carriers offers financial savings and unsurpassed service.

HCS offers claim administration on:

• Medical Plans
• Dental Plans
• Vision Plans
• Short-Term Disability Plans

Value-Based Payments

Our Value-Based Payments Solution benchmarks clients’ institutional claims costs against a Medicare-based pricing system. The calculated result is a fair and reasonable price for each procedure, plus clients still receive their network discounts for all other services.

In addition to the innovative pricing technology associated with this product, clients have a team of seasoned negotiators who work with hospitals and facilities to determine pre-procedure pricing agreements, ensuring that the facility is fairly reimbursed and mitigating the possibility that the member will be balance billed.

Learn more about Value-Based Payments (VBP) by clicking here.

Employer Aggregate Protector

Our EAP works hand-in-hand with high deductible, fully insured plans. The employer uses savings to invest in a self-funded plan below the high deductible that will now meet the needs of the group for a lower deductible. This plan allows the employer to reap the benefits of a good claim year and have protection against a poor one.

The Results:

• A fully insured HDHP will generate premium savings
• Increased control over rising healthcare costs
• Employer freedom to design their plan with the flexibility offered by a self-funded plan

Risk Management

Our risk management services produce real results while providing peace of mind for our clients. At HCS, we make sure clients have a dedicated account manager servicing their account, plus we provide support services for reinsurance needs, eligibility management, and transition management.

Account Management

HCS deploys an account management strategy that allows each client to have a dedicated Account Manager as well as a dedicated Client Service Specialist. This team sets the framework for excellent customer service and client care.

Eligibility Management

Eligibility and billing records are maintained electronically by HCS within the claims adjudication system. This allows clients to be assured that all claims, including prescription drug card transactions, are adjudicated based on the patient’s eligibility. The Consolidated Omnibus Budget Reconciliation Act (COBRA) provides certain former employees, retirees, spouses, former spouses, and dependent children the right to temporary continuation of health coverage at group rates and HCS’s process tracks the eligibility of COBRA beneficiaries.

Reinsurance Management

HCS offers complete support in obtaining and managing reinsurance products, including selection of competitive rates, negotiation of contracts, coordination of premium payment and filing of claims. All carriers we use have superior financial ratings. Our quality claims administration has resulted in preferred status with many reinsurance carriers.

Transition Management

Health Cost Solutions assigns a dedicated transition team to work with the incumbent carrier/administrator to ensure a smooth transition for the client and the members. This transition team consists of staff from Account Management, IT and Claims.

Meaningful Benefits

The backbone of our service capabilities are our meaningful benefits. HCS offers FSA/HRA programs, nationwide PPO access, and pharmacy benefits management that allow us to create truly custom solutions for your needs.

Flexible Spending Account (FSA)

Our FSA allows your employees to set aside pre-tax dollars from their paychecks to pay for qualified healthcare and other eligible expenses such as dependent childcare. Eligible expenses are reimbursed from the employee’s account.

Employer Benefits:

• Effective with any health plan
• Fully compliant with IRS regulations
• Simple administration
• Save 7.65% in payroll taxes in FICA and Medicare
• Comprehensive account visibility
• Designated account management team

Employee Benefits

• Save up to 40% on health related costs
• Convenient payment options
• Instant access to funds
• Easy online account management
• Market leading calculators and support tools
• Outstanding service experience

Health Reimbursement Account (HRA)

HRAs are flexible programs that enable employers to use tax-deductible dollars to reimburse employees for qualified medical expenses. HRA funding can come from the premium savings realized in moving from an expensive low deductible health plan, to a low-cost high deductible plan. By contributing to HRAs employers create a more attractive benefit package for employees who may object to a high deductible plan.

Employer Benefits:

• Accounts do not have to be pre-funded
• Employer retains ownership of funds if employee terminates
• Payments can be claimed as business expense deductions
• Increased health insurance flexibility
• HRA contribution amounts are customizable

Employee Benefits

• HRA is entirely employer funded
• First dollar benefits depending on plan design
• Remaining funds can be rolled over year-to-year
• Wide range of qualified medical expenses and, in some cases, insurance premiums

Nationwide PPO Access

Health Cost Solutions has access to regional and national PPO networks. It is our objective to develop PPO networks based on your employees' geographical region(s) to offer the most comprehensive savings available.

PPO networks accessed by current HCS clients include:

• CIGNA
• MultiPlan/PHCS
• HealthChoice
• MedCost
• Mississippi Physicians Care Network
• Healthlink

In addition to excellent PPO network arrangements, any claim that falls outside of the selected PPO network is sent electronically to a preferred partner to obtain an out of network discount. Based on plan design, this is typically reimbursed at the penalty level of benefits which control plan dollars and prevents employee balance billing.

Pharmacy benefits management

Through our strategic PBM partnerships, we offer comprehensive programs to control pharmacy benefit expenses. Based on our experience in the market, we have developed aggressively priced pharmacy contracts that are employee and employer friendly. We strive to educate physicians and members on ways to reduce unnecessary pharmacy spending.

For additional savings HCS applies transaction processing which ensures that all expenses are eligible and tracked back to each member to guarantee all pharmacy spending is accounted for and eligible for stop loss reimbursement.