Reporting, Re-Contracting and Settlement

Transcription

1 US HEALTH AND LIFE INSURANCE UNDERWRITING ADMINISTRATION Simple. Seamless. SafeGuard Self-Funding Reporting, Re-Contracting and Settlement

2 The SafeGuard Self-Funding Timeline Ÿ Although SafeGuard Self-Funding involves a twelve-month incurred contract period, USHL works with employers a full seventeen months in order to satisfy all stages of the program timeline Ÿ All SafeGuard Self-Funding programs have five stages: Ÿ Twelve month contract period Ÿ Claims review period for re-contracting Ÿ Plan reporting and re-contracting finalization and delivery Ÿ Claims review period for settlement Ÿ Settlement

3 The SafeGuard Self-Funding Timeline PLAN CONTRACT PERIOD CLAIMS REVIEW PERIOD (RE-CONTRACTING) CLAIMS INCURRED CLAIMS REVIEW PERIOD (RE-CONTRACTING) CLAIMS PROCESSED PLAN REPORTING & RE-CONTRACTING DELIVERED CLAIMS REVIEW PERIOD (SETTLEMENT) CLAIMS INCURRED CLAIMS REVIEW PERIOD (SETTLEMENT) CLAIMS PROCESSED SETTLEMENT PAID JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY

4 SafeGuard Self-Funding Program Stages SafeGuard Self-Funding program moves through several stages from inception to end: Ÿ The contract period runs twelve months Ÿ Reporting data and re-contracting data are presented at month ten Ÿ Incurred claims are processed for fifteen months Ÿ Settlement and resulting fund distributions occur within five months after the contract end date* Ÿ Any claims incurred within the contract period, but not received within the settlement period, will be covered by the incurred but not reported (IBNR) claims estimate * If a group terminates prior to the end of the twelve month contract period, settlement will still occur at the originally scheduled date

5 Program Reporting Ÿ Reporting provided with SafeGuard Self-Funding provides group-level utilization data Ÿ While protecting the privacy of individual members, the reports deliver non-member specific claims data including, but not limited to, information on claims paid, types of visits driving group medical costs, in-network versus out-of-network claims, and generic versus brand drug usage Ÿ USHL account management and underwriting are available to assist employers with analysis of the program reporting data highlighting what conditions or claims scenarios signal an ongoing best-fit for self-funding, or conversely, conditions in the group that may prevent self-funding from suiting the group s future needs

6 Program Reporting

7 Program Reporting

8 Program Re-Contracting Ÿ Along with the program reporting data delivered in month ten, USHL delivers to the employer a SafeGuard Self-Funding re-contracting offer Ÿ The re-contracting offer is based upon underwriting review of the group s claims experience within the first eight months of the twelve month contract, and also includes a prospective outlook for the group s subsequent twelve months beyond the contract end date Ÿ Employers wishing to continue to offer SafeGuard Self-Funding must re-contract with USHL for both administrative services and excess loss insurance coverage as each plan year contract is for twelve months and is not renewable Ÿ There is no rollover of funds remaining in the pre-funded claims account; employers who re-contract will receive the applicable settlement payment from year one, and a new pre-funded claims account will be established for year two

9 Program Re-Contracting Ÿ The re-contracting offer is delivered along with an excess loss i n s u r a n c e a p p l i c a t i o n a n d administrative service agreement; the group s most recent quarterly wage / tax report is also required for establishing the new contract period Ÿ USHL must be in receipt of all required re-contracting paperwork by the fifteenth day of month eleven to ensure no break in the group s coverage Re-Contracting Offer of Excess Loss / Policy Schedule

10 Program Settlement A settlement check is like a group s bonus for a healthy year.

11 What Happens at Settlement? Ÿ SafeGuard Self-Funding is an incurred contract: Any eligible claim incurred during the twelve-month contract period will be processed for payment according to plan guidelines Ÿ The contract settlement period extends 90 days beyond the twelve-month contract end date in order to allow time for incurred but not reported (IBNR) claims to reach USHL for processing

12 What Happens at Settlement? Ÿ At the end of the settlement period, a determination is made on potential claims outstanding yielding the IBNR Claims Estimate. This amount is held back from funds remaining in the pre-funded claims reserve account Ÿ The remaining balance is returned to the employer within five months following the twelve-month contract end date Ÿ If a group terminates prior to the end of the twelve month contract period, settlement will still occur at the originally-scheduled date

13 { Simple. Seamless. SafeGuard Self-Funding Settlement Return Illustration Moderate-Cost Claims Year Annualized Costs: Administrative Fees Excess Loss Premium Claims Pre-Fund Account Claims Total Claims Paid from Pre-Fund Claims Paid by Excess Loss IBNR Settlement to Employer $ 12,600 $ 29,4000 $18,000 $ 14,100 ($ 14,100) ($ 2,400) $ 1,500 Example A Settlement Refund $1,500 $3,000 $2,500 $2,000 $1,500 $1,000 $ $500 { - $1000 MONTH Pre-Fund (PF) Paid Claims IBNR PF Account Bal Incurred Period Pre-Fund (PF) Paid Claims PF Account Balance IBNR Run Out This moderate-cost claim year resulted in a settlement return of $1,500 to the employer.

14 For additional information on SafeGuard Self-Funding, select an option below: Speak with a Sales Representative Contact USHL Sales Support at (844) or send an to SalesSupport@ushealthandlife.com Learn more about USHL SafeGuard Self-Funding Review SafeGuard Self-Funding Benefit Designs Review Frequently Asked Questions Obtain a Quote