The WBA Employer Healthcare Plan
In recent polling of Whatcom Business Alliance members, healthcare coverage and costs were the number one concern of local employers. The WBA is pleased to be able to offer a creative solution, customized specifically to meet the needs of its members.
The WBA Exchange offers a variety of comprehensive and catastrophic medical options while decreasing costs through tax savings, transparency, elimination of excess fees, improving the efficiency of administration and increasing the pool size.
Groups eligible to participate must have at least 50 employees working 17.5 hours or more and 35 enrolled employees. Groups from 35 to 100 enrolled employees will participate in the prefunded model. Monthly premiums will be set at maximum exposure inclusive of all fees and run-out. 60 days after the 90 day benefit run-out, premiums will be returned to the group in excess of fees and claims incurred.
Groups with more than 100 employees will receive a monthly invoice for all fixed costs and a weekly invoice for incurred claims.
Employers with 35-100 employees can choose to include the WBA Bronze Option, 1 PPO option and a HSA Option. Customized plans are available for employers with more than 100 enrolled employees or currently self funded.
This program will be a partially self-funded model. Specific and aggregate reinsurance through Sun Life will be placed on all contracts in order to make it function like a traditional medical insurance plan and allow each specific company to participate in their savings. The specific deductible covers all medical expenses per insured over a preset dollar limit. The aggregate deductible covers all medical expenses per group over a preset dollar limit. The program is administered by EBMS in partnership with The Hecht Group.
Savings are obtained through a variety of methods outlined below.
- 100% Transparency
- Reporting: Monthly and quarterly reports provide information to the employer to make informed decisions about benefits, strategies and costs.
- Pass Through Prescription Drugs: We utilize a transparent pharmacy benefit manager that charges the cost of the ingredients prescribed plus a monthly per employee service fee. This removes all of the excess pricing from the typical pharmacy contracts. This saves on average 20% of a companyâ€™s prescription drug premium. Employees will be able to access all of the major pharmacies with no change to their prescriptions.
- Taxes: Several taxes are incurred on fully insured contracts that are not incurred on partially self-funded contracts.
- Competitive Strategy: By using an independent Third Party Administrator, Pharmacy Benefit Management, Reinsurance and Case Management company we create a competitive marketplace to allow the reinsurance companies to bid for the pooled business annually without disruption to the employees.
- EBMS Third Party Administration
- Specific and Aggregate Reinsurance, No Laser Contract, Monthly Accommodation, and Advanced Funding
- First Choice Network
- Envision PBM
- Utilization Review and Case Management
- Healthcare Bluebook
Premiums will be based on the demographics of each group. The stoploss contract will receive discounts based on the total Alliance size. In order to obtain pricing we need the following information:
- Census to include date of birth, date of hire, zip code, current medical enrollment (single/married/children/family) including who is waiving and why, if available.
- 2 years of benefit summaries
- 2 years of insurance premiums
- Renewal on carrier letterhead
Information to include for current self funded companies or companies with premiums rated on claims experience:
- 24 months of claims incurred report (including number of participants, number of members, premium paid and claims incurred by month)
- 24 months of large claims
For more information or to sign your company up, contact one of the certified agencies below or e-mail Tony Larson, president of the Whatcom Business Alliance, at firstname.lastname@example.org