Lifestyle Health Plans Chamber Proposal

To: Tennessee Chamber of Commerce and Industry/ Tennessee Manufactures Association From: Chamber Business Solutions, Inc Re: RFI: Health Insurance Programs, Medova Healthcare/Lifestyle Health Plans Program Date: 09/11/2019 Please allow the following to serve as a proposal to the Tennessee Chamber and Manufactures Association for an affinity discount group health insurance program for its members and partners. _____________________________________________________________________________________ Chamber Business Solutions, Inc. (“CBS”), an entity of the Kentucky Chamber of Commerce, is the national managing general agent for Lifestyle Health Plans. “CBS” serves as a partner to assist chambers nationwide to explore, implement, and execute an affinity partnership with Medova Healthcare for the purpose of selling Lifestyle Health Plans.

The Kentucky Chamber of Commerce has been offering Lifestyle Health Plans to its members since August 22, 2014. In 2018, Chamber Business Solutions, Inc was created to help other chambers replicate the program to achieve the same level of success. Today Lifestyle Health Plans is active independently in 37 states and CBS helps Chambers in ten states to provide the program to Chambers and their members.

The proposal starts with a general, bulleted outline followed by more in depth supporting content.

For additional information please contact: Hilary Morgan 859.494.5664 info@chambergains.com

Chambers enjoy exclusive benefits including: 

Complete marketing support from Chamber Business Solution including marketing and graphic design assistance that include flyers, web banners, ads, post cards, social media toolkit and more.

 

Preferred premium pricing for members and partners Sixteen different plans offered to groups with at least 2 lives. The ability to serve groups of 2 is an added benefit for Chambers, general market access requires 4 lives.



Non-dues revenue in the form of a marketing stipend paid at $5 per person per month for all business generated. Example: a group with five employees comes on to the plan through the chamber, the Chamber earns $25 monthly as a marketing stipend.



Strong medical networks: Medical networks are networks of doctors and facilities that health plans use in order to provide a broader choice of healthcare providers offering discounted services to their members. Your health plan is identified on your plan identification card. The insurance agent/broker who sells the plans assigns the network based on the best fit for the groups. Regional networks can be assigned to groups who are domiciled in a certain plan where the local/regional network is dominant with a national network assigned to “wrap” the regional one in the event an insured is traveling out of state—this ensures that the subscriber has access to care wherever they go.

Likewise, if a group is in an area without a strong regional network, they can simply utilize a national network to access care. PHCS and First Health are two of the largest and strongest national networks in the industry. In Tennessee the below networks are utilized:

o o o o

Health Partners (Regional-Jackson Area Only) www.hptpa.com  1-800-694-7888 Mississippi Physicians Care Network (regional)  1-800-931-8533 www.mpcn-ms.com First Health (national network)  1-800-226-5116 www.myfirsthealth.com PHCS (National Network)  1-800-922-4362 www.phcs.com

Completely integrated robust wellness program & added value benefits.

As Chamber of Commerce know better than any other association, workforce is the number one

issue of its members. Health and wellness are a workforce issues. Lifestyle Health is a well-rounded partner addressing not just insurance and access to care, but also the drivers of poor health that directly affect an employer’s bottom line.

Every Lifestyle Health Plan features an integrated wellness program that includes: o Up to a $500 deductible credit incentive o Unique deductible credit matching program for additional out of pocket savings o Cash reward ‘bonus bucks’ incentives for proactive health risk management o Annual online health risk assessment and biometric lab testing to engage and empower members to take steps to health lifestyle improvements o Personalized wellness reporting with predictive risk modeling to identify health risk before symptoms or disease or illness appear o Wellness coaching for high risk program participants including: • Tobacco cessation • Wellness coaching • Disease management coaching: o COPD, Diabetes, Obesity, Dyslipidemia, Hypertension o Value added integrated benefits:  Free labs with Labcorp  Integrated telemedicine with $0 copay  Free Diabetic testing supplies o $0 copay International mail order RX o Care Advocates:  Integrated care advocates empower the subscriber through to education and provide cost and care quality analysis. This helps subscribers save when they need imaging, surgery, specialty medication and more. The advocates are also trained to help assist with chronic condition and disease management. They also help the subscriber through care coordination, pre-certification, and preauthorization.

345 N. Riverview, Suite 600 Wichita, KS 67203 Phone: (316) 616-6160 Fax: (316) 616-6161 www.medova.com

Medova Healthcare Our Company In Brief

Founded in 1999, Medova Healthcare Financial Group is a healthcare management, Managing General Agency (MGA) and Third Party Administration (TPA) organization based in Wichita, KS.

Our Services: • Benefit Design & Management • Benefit Administration & Claim Processing • Premium Billing and Consolidation • Wellness & Population Health Management Services

Our Experience

• Benefit Consulting & Compliance

Over the years, Medova Healthcare has evolved from a firm focused exclusively on physician services & practice management to a full service TPA and MGA organization specializing in the design and management of healthcare benefit solutions for Employers, Professional Employer Organizations (PEOs), Associations, HR Service Companies, and Employer Purchasing Collations.

• General Agency / TPA Services

Combined, our executive leadership team has over 100+ years of professional experience in healthcare delivery, risk management and corporate group health benefits. This background and experience, coupled with our roots in healthcare provider-based services, provides us with a unique vantage point on the delivery & management of healthcare resources.

In the past 3 years, we have experienced 30-40% growth within our Corporate Health Division, due largely to our unique ACA-compliant, wellness inspired benefit program that serves to address the root causes of our escalating healthcare costs.

Our Core Products: • Lifestyle Health Plans Level Funded Group Major Medical Plans • Lifestyle HealthyEssentials Plans - Group Minimum Essential Coverage Products • Lifestyle Dental Plans • Lifestyle Vision Plans • Worksite and Group Life Master Benefit Programs

Benefit Programs In 2006, we launched our proprietary Lifestyle Health Plans group medical benefits platform, designed to provide corporate clients as well as affinity partners with a turnkey health benefit and wellness benefit program that addressed the root causes of our escalating healthcare costs – employee health behaviors.

To accomplish this, we partnered with several “A� rated carriers to offer a group-specific benefits solution that provides health benefit coverage, a behavioral based wellness and health improvement program, and wellness incentives to promote and reward employee involvement - all in a single benefit program. Based upon employer size,

we can offer an ACA-compliant, Level Funded health benefit program that maximizes the benefits to employees, while implementing cost saving opportunities for employers to stabilize benefit costs without reducing benefits.

In 2014, we added to our benefit offering by adding our Lifestyle

Dental and Vision products, specifically designed to compliment our wellness-inspired group health benefits program. Under the turnkey administration of Medova Healthcare, sponsoring employers now have the option to offer medical, dental and vision benefits in one package simplifying the benefit process across the board.

TPA Services As a licensed Third Party Administrator (TPA), we are currently operating in many states throughout the country and are constantly growing our service area based upon our growing partnerships. We are proud of the reinsurance carrier partnerships that we have developed which are

integral to our innovative, cost-effective health benefit solutions. Our integrated TPA services include Level Funded Plan Administration, Minimum Essential Coverage Plan Administration, Health Reimbursement 105 Accounts and Self-Funded Account Administration.

LEARN MORE We welcome the opportunity to put our innovation to work for you.

For more information visit us on the web at: www.medova.com or call (316) 616-6160.

Medova Healthcare 345 N. Riverview, Suite 600 Wichita, KS 67203 Phone: (316) 616-6160 Fax: (316) 616-6161 www.medova.com

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A Better Way to Control Your Healthcare Costs

Level-funded Group Health Benefits Program Featuring: • Healthcare benefit savings as compared to traditional coverage options • National and regional PPO networks with value-based reimbursement model options available

• Integrated, personalized wellness program • Price transparency tools • Care advocacy & patient care coordination • Available to employers with 4 – 500 employees

WELLNESS. ADVOCACY. TRANSPARENCY. What Makes Us Different?

Healthcare costs are consistently listed as one of the greatest concerns facing business owners and employees today. Lifestyle Health Plans believes that the only way to truly manage healthcare costs is to improve the health and wellness of our members. We are dedicated to offering quality, affordable

health benefit solutions for our members and sponsoring employers.

Our innovative plan designs, alternative funding structure, choice of network pricing models, integrated wellness, and employee incentives provide you with a unique and personalized solution to your health benefits.

Our Partnerships At Lifestyle Health Plans, we are proud of the partnerships that we have developed which are integral to our innovative, cost-effective health benefit solutions. Lifestyle Health has partnered with a select group of “A” rated carriers, value-based benefit design innovators, and wellness and behavioral change experts to offer a unique, industry-leading, level-funded health benefit option unlike any other program on the market today.

Care Advocacy

Quality, Affordable, Health Benefit Solutions

Navigating the complexities of group health benefits can be difficult for employers and employees alike. We know the frustration of not being able to reach a friendly voice to answer your questions or provide assistance when you need it. Lifestyle Health Plans and our integrated Care Advocates team are here to support our agents, clients, and members. A friendly voice and great customer service… all standards of care for you, our client.

THERE IS A BETTER WAY Control your healthcare costs by addressing the underlying chronic health and lifestyle issues of employees and their families.

Our benefit designs offer the following features: • Unique, level-funded plan designs through our health carrier partnerships.

• Best-in-class wellness program integrated in every Lifestyle plan design.

• Up to a $500 deductible credit incentive available to participating employees and their spouses.

• Unique, deductible credit ‘matching’ program for additional out-of-pocket savings.

• Cash-reward ‘bonus bucks’ incentives for proactive health risk management.

• Annual online health risk assessments and biometric lab testing to engage and empower members to take steps toward lifestyle health improvements.

• Personalized wellness reporting including unique predictive risk modeling to identify health risk before symptoms of disease or illness are apparent.

• Wellness coaching available for high-risk program participants.

• Physician office visit co-pays for cost effective access to health care providers when needed.

• Annual physicals, well-woman exams, and preventive wellness visit benefits.

• National and regional PPO network access with valuebased reimbursement models available.

• National pharmacy benefit management program for generic, preferred brand, and other brand name prescriptions through a tiered co-pay system.

FREEDOM TO CHOOSE Lifestyle Health Plans provides you with the ability to offer multiple plan options for your employees. Based on the size of your company, employees may choose from up to 4 different benefit designs offered side by side.

Base plan and buy-up plan options - all with a focus on recognizing and incentivizing your employees for their good health habits. # of EEs

max # of plan options offered

4-9 10 - 25 26 - 50 51 +

1 2 3 4

IT’S A FACT Research has shown that an individual’s health status is dramatically affected by their personal health behaviors and lifestyle choices.

•

Up to 86% of all health costs result from chronic conditions related to unhealthy behaviors.*

•

Employee incentives are a valuable tool to sustain lifestyle improvement initiatives.

•

Healthy employees are happier in their personal relationships, more productive at work, and are absent less than unhealthy employees.

*Center for Disease Control & Prevention. Accessed 2/22/2019. Available at: http://www.cdc.gov/ chronicdisease/index.htm

OUR SOLUTION

Meaningful Wellness Integration Lifestyle Health Plans offers an integrated wellness and lifestyle change program as a key element incorporated into every benefit design. Our wellness program provides a comprehensive offering which includes the same cutting-edge components of the leading wellness designs offered by many Fortune 500 type companies.

Here’s what employers are saying: “The unique formula of wellness incentives was the missing link necessary to get our employees engaged in a wellness program. It’s about time that someone figured out how to get employees engaged in improving their health to help lower our healthcare costs.”

“We’ve tried out level-funded plans before but this one is different. With Lifestyle, we have a launch-ready wellness program that we’re not having to staff up for. It really is a game changer for us.”

“It combines a great interactive website with biometric testing, action plans, challenges and future health risk evaluation tools. It has something for everyone focused on improving his or her lifestyle, not just the fitness focus. It has made all the difference in our approach to managing our healthcare costs.”

“Level-funding gives us a way to self-fund our benefits without shouldering the risk!”

- Sponsoring Employer

INNOVATIVE AND FLEXIBLE Lifestyle Health provides you with the opportunity to design the plan that’s right for your group. Based on employer size, we can offer a unique, self-funded group health benefit program that maximizes the benefits to employees, while implementing cost saving opportunities for employers to stabilize benefit costs without reducing benefits.

Advantages of our approach include: • Flexibility in carrier partners based on group size • Ability to choose network models with opportunities for valuebased pricing and negotiation • Ability to offer multiple plan designs including base plan and ‘buy-up’ plan options • A group health benefits platform that remains consistent regardless of carrier selected • Any elected deductible can be lowered through wellness program participation • Seamless claims payment and reporting

What is a Levelfunded Plan?

Lifestyle Health Plans is a unique group health benefits solution that is built on an innovative levelfunded platform and designed from an insurance perspective that differs from traditional self-funded plans. The plan is ‘level-funded’ meaning that by design, any risk to the sponsoring employer has been removed beyond the 12 months of premiums paid.

By blending a specific and aggregate insurance coverage for each specific group, participating employers are able to gain the flexibility they desire without taking on the risk associated with traditional self-funding.

A BETTER ALTERNATIVE FOR YOUR GROUP BENEFITS As a level-funded group health program, Lifestyle Health Plans are governed primarily by federal ERISA laws. ERISA plans differ from state benefit mandates, which result in lower costs and expenses for sponsoring employers. From an employee perspective, the features of an ERISA plan, as described in the Summary Plan

Description (SPD), will` be similar to the benefits they are familiar with in a fully insured plan, with co-pay, deductible, and pharmacy benefit options present. Each employee will be provided with a SPD detailing these benefits as they enroll in the Lifestyle Health program.

OFFSET FUTURE INCREASES

How it Works The monthly group health premium paid to Lifestyle Health Plans for your group is comprised of three separate components:

1.

2.

3.

1. Custom Stop Loss (CSL) Insurance Coverage 2. Administration & Excess Loss Coverage 3. Claims Fund

Your maximum annual claims, including claims run-off liability, are predetermined and you pay 1/12 of this cost each month for the 12 months of your plan year.

After you have paid this amount, there are no other charges for the claims fund. Once all claims

have been paid for the plan year, any unused dollars in the claims fund will be used to reduce future premium rate increases. In the event of plan termination, each employer is eligible to receive back any unused dollars in the claims fund.

Our Level-funded program is designed to truly ‘levelize the funding’ for your group health benefits from year to year. We recognize that the best way to stabilize employer health benefit costs is through a combined effort of accurately underwritten rates, proactive cost-containment measures, integrated wellness, patient care coordination and the ability to reinvest claim fund dollars to offset future rate increases over multi-year periods.

Rather than rate up your group to ensure a claims fund refund at the end of the plan year, our approach is designed to stabilize costs between plan years. This way, your group will have the best outcomes from an overall cost containment and population health management perspective!

SAVINGS THROUGH ADVOCACY Care Advocates Who Actually Care In the event that you need to use your health plan, it’s safe to say that no one wants to be billed for $250 for a bandaid or $400 for a bottle of aspirin. But with the lack of price transparency, this is often the case!

Through our Care Advocates care coordination, pre-certification and pre-authorization process, we make it easy for our members to not feel alone in navigating the complexities of the modern healthcare system.

a true advocate for Lifestyle members, our care coordinators will go to great lengths to educate and provide cost / quality anaysis. Whether researching compartive facility options or negotiating specific-case pricing, our Care Advocates work as a key point of contact with our members, their providers and the facilities that they utilize.

We know it’s a novel thought, but we actually believe our members should have a full picture of what their healthcare service will cost - before undergoing the treatment! Acting as

Quality Care, Priced Right Did you know that a provider will often have the ability to perform a procedure at multiple facility locations? And there can be a considerable variance between the billed charges at one facility as opposed to another, just a mile away.

Through our Care Advocates care coordination process, Lifestyle members have access to all the information they need to make an decision about the facility that is best for them. Our Care Advocates will then help to coordinate and negotiate all of the details, interfacing with provider and facility, all as an integrated component of the Lifestyle Health Plans program!

In the example below, Jane is looking for a total knee replacement. Going through our care coordination process, she gains access to the same quality care, this time priced right!

FACILITY A DR. SMITH

AVG BILLED COST

$78,000

FACILITY B DR. SMITH

AVG BILLED COST

$24,000

FACILITY C DR. SMITH

AVG BILLED COST

$29,000

*RECOMMENDED OPTION

COST MANAGEMENT STRATEGIES Other Strategies for Managing Costs By this point you’ll have to agree, Lifestyle Health Plans is committed to finding innovative ways to manage healthcare costs. Traditional benefit designs and cost management techniques have been relatively unsuccessful in assisting employers and their members with cost containment. To address the need, we’ve integrated a number of additional cost management programs and benefit coverage solutions into our plan designs.

Unfortunately, most members today are totally uneducated regarding the cost of healthcare services.

ER Utilization Emergency Room utilization has been deemed in a retrospective review to be an inappropriate place of service for up to half of all ER visits.

Implant Cost Containment Some of the highest hidden costs to healthcare consumers come in the manner in which hospitals charge for certain supplies, implants, and other misc. charges associated with a hospital admission.

Alternative Generic Drug Utilization The majority of brand-name medications on the market today have an alternative generic drug replacement that provides the same care management results, but at a fraction of the cost of brand name prescriptions.

Consumer awareness and education regarding the cost of services is a key element that makes Lifestyle Health unique. Once informed of their options, most members are open to doing their part in managing costs.

We partner with our members to provide multiple costeffective healthcare delivery options, education with regards to the cost differentials, and then freedom for the member to decide where they would like their care provided. In the end, empowering change through consumer awareness is a unique difference offered through Lifestyle Health.

Outpatient Imaging & Surgical Services Utilizing a freestanding imaging center for outpatient radiology, imaging, and surgical services needs can provide significant savings to our members.

Specialty Medications and Injectibles Specialty medications are the fastest rising cost item in healthcare today. By analyzing the current utilization needs within each group, Lifestyle Health can lower your premium costs dramatically by excluding certain medications that can be covered through other advocacy programs.

Your Benefits Integrated Benefits Overview

This Overview will provide you with details on specific value-added benefit programs designed to save you money: • $0 Copay Telemedicine • Care Coordination Services • 100% Diabetic Supply Benefit

• 100% Lab Benefit Program • Claims & Benefits Portal • $0 Copay Rx Mail Order

INTEGRATED PLAN BENEFITS

Lifestyle Health Plans... A World Of Wellness INTEGRATED TELEMEDICINE

24/7/365 for $0 Copay

Lifestyle Health Plans members can talk to a OnCall MED clinical professional anytime, anywhere.

Avoid office visit copays, urgent care visits and unnecessary emergency room visits.

Connect with a clinical professional live by calling OnCall MED. OnCall MED is a key component of every plan design at a $0 Copay.

OnCall MED offers over 240 clinical professionals and covers all 50 States. Providers are typically available within 10 minutes, and a consult is guaranteed within three hours.

Questions?

Not feeling well?

Call 1-844-746-6339

PATIENT CARE COORDINATION SERVICES

Maximize Your Plan Benefits & Manage Your Chronic Conditions with Care Advocates Managing healthcare costs and promoting consumer awareness with plan participants is a key element of what Lifestyle Health does differently.

Through our partners at Care Advocates, our Care Coordination Teams help you save when you need outpatient imaging and surgery services, specialty medications, generic medication conversions and more!

Struggling with a chronic condition?

Our Care Coordinators are trained and ready to assist with chronic condition and disease management as an integrated benefit and service for plan participants. In coordination with your provider, we can provide tools, action plans and other support to assist with managing chronic conditions. We are committed to our members!

Learn More - Call 1-844-643-5104

DIABETIC SUPPLIES Direct Shipping At No Cost!

Save on your out-of-pocket costs!

Diabetic testing supplies are covered at 100% through the Just Diabetic Solutions program. All of the testing supplies you need including a new meter, test strips and lancets - shipped directly to you at no cost!

Enrolling is easy!

Call to check eligibility.

1-316-616-6111

OUTPATIENT LAB TESTING Maximize your DirectHealth Benefit

Through the DirectHealth Lab Benefit Program, you have a 100% lab benefit when you use LabCorp.

Whenever your doctor orders laboratory or pathology, just ask him/her to attach a copy of your DirectHealth card to the requisition and follow the simple instructions on the back of the card regarding procedures for lab/path collection.

If your physician’s office does not use LabCorp as their reference lab, you will need to either request

that they draw the sample and call DirectHealth to schedule a pick up of the sample, or that they send you to the nearest LabCorp Patient Service Center with a requisition form for the required tests.

DirectHealth Questions?

Call 1-800-395-4124

Note: Due to federal regulations, the 100% lab program is not available for HealthyConsumer HDHP plan participants.

To get started, check your eligiblity for the program by calling us at 1-316-616-6111. Then complete a simple member enrollment form (available in your Lifestyle Member Welcome Packet). You will receive a welcome package with the startup kit once your enrollment is processed.

Note: Due to federal regulations this benefit cannot be offered in plans that are qualified HDHP plans without cost sharing by the member. However, these individuals can contact Just Diabetic Solutions for discounted purchasing options.

CLAIMS & BENEFITS Online Member Portal

Lifestyle Health Plans offers members, dependents and providers online claims status and benefit information through our easy to use Claims / Benefits Web Portal.

Portal offers real-time access to eligibility and claim information and allows members to view, print and save your Explanation of Benefits (EOBs) at the click of a mouse! Access to your EOBs is at your fingertips - create an account today!

1. Go to www.lifestylehealthbenefits.com and select the Claims / Benefits tab at the top right of our Home Page. For first time users, select Create Account to setup your own personalized account.

2. Next, create a User ID and Password.

3. Once you have accessed your account, click My Claims at the top menu and you will have access to view, print and save your EOBs while online!

Questions? Call 1-866-827-6607

INTERNATIONAL MAIL ORDER RX for Brand Name Maintenance Medications Members can enjoy $0 Copay for select Brand Name maintenance medications.* Medications are shipped in factory-sealed packaging, direct to members from governmentlicensed pharmacies in Canada, the United Kingdom, Australia and New Zealand (Tier-One countries).

This optional program wraps around our current prescription benefit coverage and is based on voluntary participation. Eligible participants can obtain certain maintenance medications at $0 cost, with no shipping or handling charges!

To learn more and get started visit: www.lifestylehealthCRX.com

*Formulary can be found on the CRX website, on the enrollment form, or by contacting a CRX Customer Service Representative at 1-866-488-7874. The International Mail Order Rx medication list is subject to change.

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CHAMBER BUSINESS SOLUTIONS BENEFITS PROGRAM Health benefit costs rank as one of the top concerns for Chamber members today. This program provides member companies with an innovative solution to help control health premium costs. By offering affordable coverage along with proactive cost management & employee wellness features, member companies can strategically manage healthcare costs while still maximizing employee benefits.

Deductible

$1000/1500/2000/2500

$2500/3000/3500/5000

$2500/3500/6850/10,000

Wellness Deductible Credit

$500 Deductible Credit

$500 Deductible Credit

$500 Deductible Credit

80/20

None

50/50 | None

None

Office Visits Copay

$30 / $50

$30 / $50

$30 / $50

Deductible / Co-insurance

Hospital ER Visits 2

$250 Copay

$250 Copay

$250 Copay

Deductible / Co-insurance

Urgent Care Visits 3

$50 Copay

$50 Copay

$50 Copay

Deductible / Co-insurance

$1/$15, $50, $80

$1/$15, $50, $80

$1/$15, $50, $80

$1/$15, $50, $80 1

$25 Copay

$25 Copay

$25 Copay

Deductible / Co-insurance

100% thru Lifestyle

100% thru Lifestyle

100% thru Lifestyle

Deductible / Co-insurance

$0 Copay

$0 Copay

$0 Copay

$0 Copay

100% thru Lifestyle

100% thru Lifestyle

100% thru Lifestyle

Deductible / Co-insurance

Co-insurance

Rx Drug Benefits Copay Allergy Treatment Diabetic Testing Supplies Telemedicine Consult Lab Testing

$3000/3500/5000/6500 $500 Deductible Credit

For questions about the program or to receive a proposal, contact:

SAMPLE MEDICAL RATES

HILARY MORGAN

PLAN OPTION

HealthyChoice 1500

Healthy100 3000

HealthyValue 6850

HealthyConsumer 5000

Employee Only

$375.80

$352.12

$296.06

$285.40

hmorgan@kychamber.com

Employee / Spouse

$807.97

$757.05

$636.53

$613.62

Employee / Child(ren)

$732.81

$686.63

$577.32

$556.54

$1,116.13

$1,045.79

$879.31

$847.65

Each client group will go through underwriting. Premiums may be higher or lower based on underwriting results.

at (502) 848-8724 or email

Family

After deductible is met. 2After Copay then 100% to $500 per visit, then Deductible/Co-insurance. 3Hospital ER Facility Charge Only, after Copay then Deductible/ Co-insurance. Copay is waived if admitted. * Groups of 4-9 employees can choose two plans. Groups of 10-25 employees can choose three plans. Groups of 26+ employees can choose up to four plans. ** Groups must have at least 4 enrolled employees to be eligible for the plan. Eligibility for all plans is 30 hours, governed by ACA. Plans are underwritten by our re-insurance partners and utilize various provider networks throughout the country. Contact your Lifestyle Sales Representative for more details.

1

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FREQUENTLY ASKED QUESTIONS Q: Because this program is technically a ‘SelfFunded’ Program, does that mean our group has to have reserves set aside to cover the claims in case of a bad month (or year)?

A: NO. Because of the insurance components of the program, we have taken the best aspects of a selffunded program and the best aspects of a fully-insured program and blended them together. This is a fixed-cost, level-funded program. Your rates are your rates, period.

Q: What does Level Funded mean?

A: The Lifestyle Health Program is ‘level funded’ meaning that by design, any risk to the sponsoring employer has been removed beyond the 12 months of premium paid. Based on employer size, we can offer a unique, self-funded health benefit program that maximizes the benefits to employees, while implementing cost-saving opportunities for employers to stabilize benefit costs without reducing benefits.

Q: If our claims exceed the allotted amount, what happens? Do we have to come up with the difference at the end of the year?

A: NO. The Lifestyle Health Program is level funded by your monthly premiums. Regardless of what your claims experience is in any given plan year, you will never pay more than the monthly cost quoted to you

Q: If we choose to leave the program at the end of the plan year, is there a termination cost associated with the plan?

A: NO. All run out costs are accounted for within the monthly premiums.

Q: During our plan year, what if our claims run better than expected?

A: Once all claims have been paid for the plan year, any unused dollars in the claims fund will be used to reduce future premium rate increases. In the event of a plan termination, each employer is eligible to receive back any unused dollars in the claims fund after the run out period.

Q: Will our employees and administrators have to do more work on this type of program?

A: NO. By partnering with Medova Healthcare, the program’s Third-Party Administrator (TPA), administrative burdens are removed from both the employee and the CHAMBER employer. Employees play their usual role including BUSINESS within their PPO Network, using their S O Lseeing U T I O providers NS ID card at the provider’s office, paying a copay and then paying their shared responsibility. The employer simply pays their monthly premiums. Medova then handles the rest! No claims filing, no separate accounting, no extra work!

Q: Are there any startup costs to our Lifestyle Health Plan?

A: The only start-up cost is your first monthly premium payment.

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Q: Will my employees still have access to their hospitals, doctors and pharmacists?

A: By choosing from multiple national and regionally based PPO networks, we try to match up the providers as well as possible. As with any change in carriers, some providers aren’t in every network. We thoroughly examine the networks that are available during the decisionmaking process.

Q: What about the benefits? Will they be ‘apples to apples’ to our current plan?

A: The Lifestyle Health Program offers 16 different plan designs that your group may select from. Depending on the group size, up to 4 plans can be offered to the employees to choose from. While there will be some differences between the LHP plans and your current plan, we should be able to improve the benefits to the employees by offering a deductible credit through the Wellness Program as well as some other value-added benefits (Care Coordination, Lab Benefit, Diabetic Supplies, Telemedicine, Rx Benefits, etc.).

Q: What are some of the cost-containment features with our Lifestyle Health Plan?

A: A key focus for Lifestyle Health Plans is finding creative ways to manage healthcare costs. Traditional benefit designs and cost management techniques have been relatively unsuccessful in assisting employers and their members with cost containment. Lifestyle Health has integrated a number of cost management programs and benefit coverage solutions into our plan designs.

Some of these address ER utilization, implant cost containment, specialty medications and self-injectables and alternative generic drug utilization.

Q: I have never heard of Lifestyle Health Plans.

Will my doctor recognize it? Is this a new program?

How do we know that it won’t fail? I know my current carrier and they are huge.

A: Lifestyle Health Plans is an innovative, boutique health benefits program and has been offered throughout the country since 2006 in partnership with a host of A-rated reinsurance carrier partners. Since Lifestyle relies on PPO networks for discounts and re-pricing, it is important to use a doctor in the network selected (just like your current plan). On your Member ID Card, you will find a logo for your plan’s PPO Network. Your provider will recognize the PPO Network even if they have not yet had extensive experience with Lifestyle.

Q: What are the benefits of having a Third-Party Administrator (TPA) handle our claims versus having a carrier do it?

A: Many would say that traditional carriers are first concerned with their bottom line, not yours. A ThirdParty Administrator (TPA) works solely on your behalf and has your group’s interests in mind. As the program administrator, Medova Healthcare strategically partners with each client company to proactively address factors that contribute to the rising cost of healthcare. Plus, wouldn’t it be nice to speak directly to the person who pays your claims versus a different customer service person every time you call? At Lifestyle Health Plans, our committed member and client service teams are here to support our agents, clients, and employee members. A friendly voice and great customer service… all standards of care for you, our client.

Q: What options are available to ensure that my group is ACA-compliant?

A: For groups of over 50 eligible lives, Lifestyle Health Plans offers a turnkey solution for group medical benefits, including five Minimum Essential Coverage (MEC) Plans and a variety of plans that meet Minimum Value. In addition, from the standard 16 plan designs, there are also a host of ‘buy up’ options for richer benefits. The whole program offers turnkey administration and billing through Medova Healthcare.

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