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Do you know how your healthcare dollars are spent?

• Why do my healthcare premiums increase so much every year?
• How healthy is my workforce?
• What can I do to control costs?

Organizations find themselves asking the same questions year after year, with nowhere to turn for an answer. The overwhelming call for competition in the healthcare marketplace has prompted us to answer the difficult questions and offer an economical alternative in an easily implemented, self-funded program.

Self-funding your healthcare program is not a new concept. Budgeting future expenses, monitoring spending trends and auditing operations for quality assurance are not, either. Creating transparency in billing practices, passing through savings to the member and reporting on every dollar spent are not new concepts, but may be harder to find. The combination of such fundamental practices, and so much more, is what makes our product unique to the healthcare marketplace.

Isn't it time your organization takes advantage
of a good opportunity and starts
saving money on its health benefits?

With INDECS you will.

Overview

• Eliminate or substantially reduce state guarantee-fund assessments and premium taxes
• Implement only those state mandates which are appropriate for the group
• Keep all excess claim funds
• Underwrite renewals based on the group’s own experience

The INDECS Advantage has been designed to provide plan sponsors with the opportunity to offer a self-funded healthcare program of the highest quality to their members, at the lowest possible cost, and with the least administrative effort.

Self-Funded Plans Provide Efficiency and Flexibility

Self-funded health plans have long been the preferred method of providing higher value healthcare to plan members at a lower cost to the plan sponsor; two thirds of the covered members in the country participate in some variant of a self-funded health plan. With the number of self-funded health plans on the rise (by 20%) over the past few years, now is the time to bridge the gap between appealing concept and business reality.

INDECS has compiled the following components to enable you to successfully sponsor your
self-funded health plan:
Third Party Administration
Provider Network
Medical Management
Stop Loss Coverage
Pharmacy Management

Over the past 40 years, the INDECS team has developed the relationships necessary to deliver these components in the most comprehensive and professional manner and at the lowest net cost possible.

Third Party Administration

INDECS acts as an extension of your organization by communicating your benefit program to your membership with care and uses your management philosophies, while overseeing your plan funds, as though they were our own.

Payment of Claims

We provide timely and accurate claims payments for self-funded plans. State-of-the-art claims-processing systems allow us to auto-adjudicate most claims, while integrated processing control mechanisms minimize improper claims payments.

Overpayment Mitigation

We are proactive in our approach to identify errors in claim processing before a check is issued. Errors that may be detected before the claims are paid include: fraud and abuse, provider coding errors, coordination of benefits, work related injuries, and third party liability. By utilizing the latest in clinical editing software, audit processes, and investigative procedures, we limit your exposure to claim overpayments that often result in costly recovery procedures. We include these services at no additional charge to prevent improper claim payments before they occur.

Customer Service

We believe in having people answer phones, not machines or recordings. Using the latest telephonic technology, we have created an environment where your membership will be provided prompt and courteous service by a qualified professional. Our, friendly, staff will resolve your issues expeditiously. There is no issue too big or too small.

Resources

Many of our staff have worked at INDECS for more than 10 years, some as long as 28 years. We maintain a positive work environment where our seasoned professionals can achieve their highest potential. Though INDECS hires legal U.S. residents and only contracts with U.S. vendors located within the U.S., our customer service staff is multi-lingual, enabling friendly communications in different languages.

Benefit Plan Design

We have the ability to recreate your plan design to your specifications. More importantly, we collect every bit of data generated by your healthcare program, which we then make available to you, your members and their physicians in a convenient, easy-to-understand format. With this data analysis, we empower you to make plan design decisions which enable you to control your costs and ultimately keep your membership healthier.

Web Access

All of our clients have access to our HIPAA secure web portal. Here, your plan data resides for user specific access by your members, plan administrators, healthcare providers and consultants. Plan members may review benefits or view their claims. Plan administrators have the ability to enroll members and access eligibility data. Consultants may download reports for viewing. Access permissions are programmable to client specifications.

Reporting

Our reporting packages offer hundreds of options which allow you and your consultants to gather needed information conveniently and in the format of your choice to effectively manage your health plan. Sample reports are available for your review upon request.

Provider Network

Members rely upon a provider network to grant access to a wide variety of doctors and medical facilities at an affordable price. INDECS utilizes the largest, national networks for access to the largest number of doctors and most exclusive facilities at the deepest discounts available.

Access to the top two national provider networks, and dozens more

You can access the Aetna Signature Administrators National and Anthem/Wellpoint Blue Cross networks as well as First Health, MultiPlan, GHI, QualCare, MagnaCare, and many other regional PPO networks.

Up-to-date provider directories available online

You can look up network providers and services through INDECS’s website to find the in-network provider that is most convenient for you.

Health ticket allows you to print your plan benefit to take with you to your appointment

As part of the provider lookup on the website, you can print out a health ticket indicating member-specific information, plan coverage, out-of-pocket cost and other visit instructions.

Specialty transplant networks

You may access several medical services from transplant networks including Cigna LifeSource Network, Aetna Institutes of Excellence Transplant Network and others.

Choose from Centers of Excellence

In addition to being able to access most hospitals and other medical facilities through preferred provider networks, INDECS also offers access to Centers of Excellence established by these PPOs or we ­­can customize access to meet your needs.

Creation of customized provider networks

INDECS has the ability to help you develop high-quality Centers of Excellence networks to direct your members for specialized care based on factors such as outcomes, cost, efficiency and other important factors, which can save substantial plan dollars.

Medical Management

Medical Management, a crucial element of every health plan, provides the clinical element to manage, maintain and restore the health of your members. Medical management services allow each and every member to reach their optimum health, while reducing medical costs for the plan.

Care Counselor Utilization Management (UM)

URAC Accredited program is designed to verify treatment and provide alternatives to control costs.

Large Case Management (LCM)

LCM manages members with the most complex and catastrophic medical conditions that are generally responsible for a plan’s greatest healthcare costs.

HealthReach (HR)

Members with multiple risk factors are contacted by a Registered Nurse who provides resources to help members achieve a happier, healthier lifestyle.

Pharmacy Review

Identifies alerts (such as drug interactions or duplicate therapy) based on a review of prescription data and communicates findings to prescribing physicians.

MaterniCare

Registered Nurses work one-on-one with expectant mothers, while providing education and support to help promote a healthy pregnancy and delivery.

Medical Information Helpline

Provides direct access to a Registered Nurse 24 hours a day, 7 days a week.

Stop Loss Coverage

The purchase of Stop Loss insurance protects your self-funded plan against the financial consequences of large individual claims or an unusually high number of claims for the entire group. This coverage protects against losses that exceed the predetermined amounts. If losses do exceed these levels, the Stop Loss insurer steps in to absorb the excess costs.

Stop Loss insurance is available in two forms – Specific and Aggregate.

SPECIFIC STOP LOSS limits losses for any one individual. Specific losses above the Stop-Loss amount are reimbursed to protect the plan sponsor against unexpected and unusually large individual claims.

AGGREGATE STOP LOSS effectively sets the maximum limit of all claim losses in any given plan year. Claims in excess of the Stop Loss amount are reimbursed to protect the plan sponsor against unexpected frequency or severity of claims for the entire group.

A number of contract year options are available including those which provide credit for prior-year incurred claims and/or claims paid after policy termination:

15/12, 18/12, 24/12 — Calculation of the Stop Loss limits includes run-off claims from a prior carrier that are incurred in the 3, 6 or 12 months prior to the effective date and paid during the first policy period.

12/12 — Calculation of the Stop Loss limits includes claims incurred and paid during the first 12-month policy period.

12/15 — Calculation of the Stop Loss limits includes claims incurred in the first 12-month policy period and paid within the first 15 months.­ Terminal Liability Option — Provides additional Stop Loss protection at policy termination.

All options are available and can be explained at our first visit.

Pharmacy Management

A Pharmacy Benefit Manager (PBM) offers services to control the cost and utilization of prescription drugs.

Pharmacy Networks

Full network of retail pharmacies provides convenient access to prescriptions. Customized-networks can be created to meet your unique needs with additional savings.

Mail-Service Pharmacy

A Mail-Service Pharmacy delivers maintenance medications at a substantial savings.

Formulary

Clinical experts have developed a drug list known as a formulary based on the best clinical outcomes and safety which delivers the lowest net overall costs.

Flexible Plan Design

By using different co-pay tiers, co-insurance percentages, deductibles and clinical edits, clients can encourage the use of lower cost drug alternatives when appropriate.

Pharmaceutical Manufacturer Rebates

100% pass-through of all rebates at the point-of-sale.