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What is Healthcare Sarasota?
Healthcare Sarasota, Inc.
is a not-for-profit corporation formed in 1993 as a healthcare coalition of four
government entities - The City of Sarasota, the Sarasota County School Board,
Sarasota County Government, and Sarasota Memorial Hospital. Healthcare Sarasota
offers employers six self-insured plan designs which include a comprehensive
list of healthcare services. With over 26,000 covered lives in private sector
business and government, Healthcare Sarasota is the largest healthcare provider
in the tri-county area.
What is the purpose of Healthcare Sarasota?
Healthcare Sarasota was formed with the goal of
controlling and managing healthcare costs for its founding members. The sheer
size of the group would provide the coalition with maximum provider discounts,
quality healthcare initiatives, and increased buying power.
The purpose
of the coalition is to:
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provide a
quality healthcare delivery system at the most affordable price
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provide our
members with open access to care
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evaluate
health care services
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negotiate
health care contracts and bind coverage
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provide
cost-effective quality health care benefits
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provide
innovative ideas to reduce medical costs while maintaining quality of care
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promote
wellness and preventive medicine programs
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monitor vendor
performance and initiate benchmarks
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act as an
advocate for its members
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inform its
members of new health care initiatives, technology, healthcare legislation,
and statistical data
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educate
employers and employees so they can make informed health care decisions
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encourage
other employers to take advantage of the coalition's group purchasing
arrangements by becoming Associate Members
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improve the
quality of life for all Healthcare Sarasota members
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promote Healthcare Sarasota as the provider of
choice
What provider network is used?
Members residing in
Sarasota and Manatee Counties utilize the Gulf Coast Provider Network.
Evolutions is accessed outside these counties.
What is self-funding and self-insurance?
Self-funding is the more commonly used term to
describe a plan sponsored (claims are funded and paid for) by the employer
rather than an insurance company. Self-funding your health benefits has many
advantages over conventional fully-insured plans. Self-funded health plans put
control back into the hands of the employer and employee, allowing employers to
be in touch with the health of their employees.
How
does self-funding work?
Under a fully-insured program:
A
monthly premium is paid to an insurance company. The insurance company pays
claims and administrative expenses from that premium. The difference between
the premium paid and what is not used for administration or claims is profit to
the insurance company.
Under a self-funded program:
The
employer pays its “premium” not to an outside company, but into the employer's
zero balance health fund bank account from which the plan administrator pays
employee claims directly. Unused funds at year-end belong to the employer -
not to an insurance company.
What are the benefits to self-funding?
This preferred form of administering and paying for health insurance benefits by
employers has a number of advantages over fully insured plans:
Approximate
% of Savings Over Traditional HMO Plans
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there are no HMO state or federal mandates
3%
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cash flow advantages/reserves-only pay incurred claims 1-2%
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savings from State premium taxes
1%
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saving from lower administration costs
3-7%
Other benefits …
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self-funding allows for more flexibility of plan design and greater
administrative control
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ancillary healthcare services can be tailor made to fit your group's needs
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stability - once an employer is self-funded they rarely change back
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improved employee relations
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effective use of cost-containment data
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flexible wellness, disease management, and preventive medicine programs
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control over employee healthcare education based on utilization and lifestyles
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cost control - more effective use of cost containment programs
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a
plan that provides open access to any provider in our network
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no gatekeepers, no referrals - even for out of network providers
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online capabilities for eligibility and claims information
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customized monthly and quarterly management reports
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local management team to respond quickly to your needs
How can an employer contain the risk?
Risk - the employer's potential financial exposure - is contained by stop loss
insurance..
There are two kinds of stop-loss insurance.
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Aggregate
- protects the employer's total annual liability. At 125% over the total
anticipated claims cost, the stop-loss kicks in and the company's liability
for claims stops. For example, if analysis shows that claims are anticipated
to be $100,000 per year, stop-loss insurance is purchased to cover the
employer for claims that arise at 125% of that amount. The stop-loss would
cover anything over $125,000 in claims for a given year.
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Specific
stop-loss insurance sets a limit for any
one
individual's annual claims.
The
total risk for a self-funded plan may be slightly higher than under a
traditional fully funded plan, but the cost of health insurance can be much
less under a self-funded plan with stop-loss insurance providing the safety
net.
What other fees are involved in self-funding?
A
“Per Employee Per Month” fixed cost fee is paid to the plan administrator.
Health Sarasota has an arrangement with a claims administrator that may be
offered as part of the program. Fees include:
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Network access
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Reinsurance premium
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Utilization management
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Fees for other negotiated benefits including flex administration, COBRA,
dental, and HIPAA certificate compliance
Web-TPA
Healthcare Sarasota's benefits administrator, Web-TPA, Inc., has
an excellent track record, and their extraordinary client retention rate of 95%
reflects their commitment to a superior level of service. Web-TPA provides
robust monthly
and quarterly reports, courteous customer service and
guaranteed
performance standards.
Our
Community Healthcare Commitment
“It is not enough in today's fast paced healthcare environment to simply provide
benefits. Healthcare Sarasota is committed to enhancing the welfare of our
community through ongoing employer and employee education on subjects like
stress reduction, smoking cessation, weight control, exercise and nutrition. We
actively promote well care and preventive care, and reach out to our members
through our newsletters, posters, brochures, and our annual health fair for
Healthcare Sarasota members only.”
Robert
Blinch-Edwards
Executive Director
Healthcare Sarasota
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