Health Plans, Co-Ops and Insurance Companies

HealthPlanAs health plans adapt to changes in the U.S. health care industry, they are experiencing unprecedented pressure to control costs, improve quality and maintain competitive pricing. Dubraski & Associates is the largest, most experienced broker and consultant in the managed care stop-loss business. We provide our health plan clients with value-based recommendations and solutions that will meet their goals and that will ensure their financial protection.

Customized Solutions

No two health plans are alike. Our associates are highly specialized, recognized leaders in the health care brokerage industry. They have worked with all types of health plans: national to regional, publicly traded to provider owned, commercial, Medicare and Medicaid, as well as health insurance cooperatives. With our client’s input, we will develop customized solutions.

Reinsurance Programs

While there are certainly things that can be done at the health plan level to assist clients in meeting their objectives, Dubraski & Associates also has extensive experience and strong market relationships in the reinsurance marketplace. That means our associates can work closely with health plans to develop a variety of reinsurance structures to efficiently meet their goals.

Specific Stop-Loss Reinsurance: Protects the health plan from volatility due to expenses of individual a catastrophic case.
Quota Share and Aggregate Reinsurance: Preserves capital to support the existing business and to support future growth initiatives and the overall finances of the organization.
Specialty Carve-Out Programs: Allows the health plan to limit or even remove certain risks, such as transplants, by ceding that risk to a reinsurer.
Reinsurance For Capitated Providers: Provides a pass-through or a partnership strategy with health plans that incorporate a capitation structure and may have a need to provide reinsurance to these at-risk entities.
Alternative Funding Programs: There are also various alternative funding programs available in the marketplace that may be developed based on the needs of a health plan, such as cash-flow management, protection from frequency of claims, and utilizing the health plans captive insurance company and others. Contact us to learn more about the types of reinsurance programs that may be available to you.

Administrative Services Only/Self Funded Strategy

Since 2003, the fully ensured risk enrollment has decreased each year with a total drop in membership of 10.2 million lives. Conversely the Administrative Services Only market has seen growth of almost equal proportion or 10.4 million lives. This trend is expected to continue at an accelerated rate. To respond, many health plans are working on a strategy whereby they can capture or grow market share in the self-funded employer space. While this is a fairly mature market in which third party administrators, insurance companies and reinsurance companies have been entrenched for many years, health plans bring a value proposition that challenges some of the most mature players.

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ASO/Self-funded Options

Outsource Employer Stop-Loss -The health plan may outsource the function of obtaining employer stop-loss to us. This allows the health plan to utilize the wholesaler’s access and leverage to obtain the optimal program structure and pricing for its target self-funded groups. Partner with a Reinsurer – The health plan may partner with a quality reinsurer to write the employer stop-loss, while at the same time participating in the program through a profit sharing or risk sharing agreement. Under this structure, the health plan maintains a level of control over the pricing and the servicing of the stop-loss program. Write Employer Stop-Loss Directly – The health plan may use its own license, where appropriate, and write the employer stop-loss directly. At the same time it may work with a reinsurer to assist in program pricing, product filing, and risk transfer. Licensed (and A.M. Best rated) insurance paper can be provided where needed. Contact us to learn more about our ASO/Self-funded strategy.

Out of Area Strategy

Regional health plans may be at a disadvantage if coverage is provided for groups that have employees residing outside the health plan’s service area. Dubraski & Associates has very broad reach, expertise and the resources to develop a program designed specifically for each target group.

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Dubraski & Associates has the capabilities to offer two distinct options to these regional health plans:

  • The health plan may partner with a company that provides a turnkey solution for writing members outside the service area. Depending on the level of control the health plan wishes to maintain, there is flexibility in structuring this program.Please note: The foundation is in place to bring such a product to the market for your health plan in a relatively short period of time. This solution is ideal for those health plans that anticipate a fair amount of activity prospecting national employer groups.
  • If the number of national employer groups that are targets for your company can be narrowly defined, a more strategic approach may be warranted. We can tailor a strategy that provides you the best economics to win the business. Dubraski & Associates will coordinate the entire process and deliver a streamlined economically attractive option for this employer.

Program Features:

  • The health plan will have access to a licensed insurer that has the authority to underwrite business in states in which the health plan is not licensed.
  • The health plan will have access to a strong national provider network with contracts that will keep the overall employer group pricing competitive.
  • The program has the licensing and administrative capabilities in place for the out-of-network component. As a result, the time to market is more streamlined.
  • Depending on the financial structure, the health plan will maintain control over the employer group pricing.

Group Life and Disability Consulting

With expertise in the procurement and cost reduction of group life and disability, Dubraski & Associates uses a proprietary web-based insurance exchange platform that streamlines the insurance contracting process. This can be for the health plan itself as well as for the health plan’s employer groups. Our unique approach invites qualified carriers to participate in an online, reverse auction bidding process. In 2011, this process saved groups an average of 24% using a disciplined, qualification-driven procurement approach. Weighing on both technical and financial scoring, we deliver simplicity, savings and superior benefits.

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Voluntary Benefits

More companies are offering voluntary benefit options as a way to meet the needs of a diverse workforce, to recruit and retain qualified employees and to supplement core coverage without adding any additional costs to the employer. Dubraski & Associates has relationships with all the major voluntary benefit carriers and has partnered with the leading enrollment and communication firms.

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Our team will help fill the gaps in your core program with popular voluntary benefits such as:

  • Permanent and term life insurance
  • Accident coverage
  • Short-term and long-term disability insurance
  • Dental insurance
  • Vision insurance
  • Long-term care
  • Limited medical plans
  • Critical illness insurance

Additionally, we offer unique administrative services to relieve human-resources staff of additional responsibilities, including:

  • Deduction and billing reconciliation
  • Assumption of service and billing functions for existing voluntary programs
  • Web-based benefits administration tools
  • Dedicated employee client service center
  • Policy and deduction changes
  • Choice of single or multiple payroll deduction fields

Voluntary Benefit Programs can be developed for:

  • The health plan itself and/or health plan’s employer groups

Pharmacy Management

With more than 11 million lives under management, our pharmacy management partner brings leverage and expertise to assist you in managing your pharmacy benefit management contract. The minimum savings they have achieved is $2.50 per pharmacy claim.

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Emergency Assistance/Travel Benefits

This program provides assistance to your members who require emergency medical treatment away from home. Benefits include:

  • medical consultation
  • emergency medical evacuation
  • care of minor children
  • medical repatriation
  • emergency trauma counseling
  • and other services

Property & Casualty

We focus on the delivery of insurance brokerage and consulting services for the following key areas for health plans:

  • Managed Care Errors & Omissions Liability
  • Management Liability (Directors & Officers, Employment Practices, Fiduciary and Crime)
  • Data Privacy Breach Response Management and Information Security Liability
  • Property, General Liability, Automobile and Umbrella Liability

To learn more about how Dubraski & Associates can help health plans, co-ops and insurance companies, contact us. 1.877.792.4640