INSIGHT Edge
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Smaller employer groups have historically been unable to self-insure due to the lack of available competitive products in the reinsurance market. Now, HealthSmart offers an extremely simple bridge to self-funding with an aggregate-only product providing the benefits of traditional self-insuring while maintaining the look and feel of a fully-insured group health plan. INSIGHT Edge is a fast and simple start to self-funded healthcare benefits for small to midsized employers. With INSIGHT Edge, HealthSmart can give your clients a fully integrated healthcare plan for maximum efficiencies and savings. INSIGHT Edge includes our Accel PPO network, predictive population management, PBM services, claims administration, and an innovative aggregate-only stop loss product.
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CONTENTS:
Keys for Your Success
The INSIGHT Edge Advantage
INSIGHT Edge Risk Solution
Integrated Health Plan
Requesting a Quote
Plan Design Options
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- Fully-integrated services on a single healthcare administration platform
- Simplified plan options, including dual option, consumer driven and other custom designs SEE PLAN DESIGN OPTIONS
- Network solutions that provide industry leading discounts with national capabilities
- State of the art predictive modeling, partnered with aggressive disease and case management, that sustains lower costs and healthier members
- Rx program offers the best net pharmacy costs with access to over 60,000 pharmacies nationwide
- Average plan savings in excess of 60%
- Stop-loss coverage available through HealthSmart Reinsurance Solutions
Keys for Broker Success
- Simple Quote Process
- No Lasering
- Cash Back Feature for Employers
- Build your own broker compensation by deciding how much you earn for servicing the customer
- Flat dollar amount paid on a per employee per month basis
- No loss of compensation for moving customers to the INSIGHT Edge self-funded plan
The INSIGHT Edge Advantage
- Maximum cost savings of a budgeted self-funded plan
- Very competitive with existing fully-insured options
- Simplified plan designs deliver ultimate savings SEE PLAN DESIGN OPTIONS
- Fully-integrated managed solution controls costs and improves members’ health
- Competitive total cost, combined with the peace of mind obtained from a known budgeted amount
INSIGHT Edge Risk Solution
- This aggregate-only product is driven by an innovative stop loss product provided by an A- rated carrier (A.M. Best)
- Caps risk based on expected claims factors and fixed cost
- Maximum cost is much lower than traditional specific and aggregate products and favorably resembles a fully insured program
- No lasers will be placed as a condition of renewal
- Carrier will automatically and immediately fund any claims above the monthly premium equivalents
- Cash back feature should the actual claims come in lower than the attachment point at year-end
Integrated Health Plan
INSIGHT Edge is a fully-integrated healthcare solution and includes several of our wholly-owned products and services bundled together for ultimate employer savings:
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Benefit and Claims Administration
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Comprehensive healthcare plan administration
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HealthSmart Accel PPO Network
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Strategic and unique partnerships with market leading regional providers
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Care Management and Wellness Programs
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Aggressive care management through predictive modeling, case management, disease management and wellness initiatives
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Pharmacy Benefit Management
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Reducing pharmacy expenses through transparency and focus on generic utilization
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Risk Management Services
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Innovative aggregate-only stop loss product provided by an A- rated carrier with a cash back feature should claims come in lower than the attachment point at year end
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Requesting an INSIGHT Edge Quote
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INFO REQUIRED TO OBTAIN QUOTE
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UNDERWRITING GUIDELINES FOR QUOTES
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CONTACT FOR REQUESTING QUOTE
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- Company name & location
- Effective date
- Industry description or SIC code
- Census data including: date of birth/age, gender, zip code, coverage tier
- Current & renewal schedule(s) of fully-insured benefits & rates
- Requested brokerage compensation
- Available experience data
- Any known large claimants or ongoing/ serious health conditions
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- Minimum: 25 Covered Employees
- Maximum: 200 Covered Employees
- Group must currently be fully-insured
- Quotes can be locked in up to 30 days before the effective date with completed disclosure
- Preferred contract basis with INSIGHT Edge terminal liability option
- First year: 12/12 contract
- Renewals: 24/12 contract
- Minimum of 50 enrolled employees to offer dual-option plans; smaller groups must elect a single plan SEE PLAN DESIGN OPTIONS
- Triple-option plans are not permitted
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To request a Healthcare Plan Proposal, please contact our VP of Sales Support:
Ryan C. Austin, MBA
sales@healthsmart.com
VP of Sales Support
222 W Las Colinas Blvd Suite 500N
Irving TX 75039
(t) 214.574.2462
(f) 214.574.2348
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