October 30, 2013 – SOUTHFIELD, Michigan – For more than two decades, EHIM has remained committed to offering innovative healthcare solutions to organizations and businesses across the United States. Despite the speculation of what 2015 will bring, EHIM will continue to offer customized pharmacy programs that provide hands on clinical management which result in significant cost savings to our clients. Our EHIM Cares program has saved our clients over $3M alone since its inception in 2011.
In spite of the confusion and what is being communicated by many insurance carriers on their stance of carve-out programs, EHIM’s self funded pharmacy program continues to be a viable healthcare option for employer groups.
We encourage all clients to take advantage of the transitional rules that apply in 2014 with respect to carve out. In addition to the financial savings that can be achieved with a self funded pharmacy benefit, there are other benefits to a client and their members with pharmacy carve out:
- In 2014, as EHIM understands under the Affordable Care Act (ACA) clarification FAQs that were issued in February 2013, plan sponsors are not required to implement a maximum out of pocket accumulator for the pharmacy program, if the pharmacy benefits are administered by a separate vendor than your medical benefits and the group does not currently have a maximum out of pocket in place.
- With a self funded prescription benefit program, groups are generally not obligated to meet the “metal” plans nor are they mandated to include all “essential” health benefits.
- The new “insurance tax” under the ACA is NOT assessed on self funded benefits. This “insurance tax” will only be assessed to fully insured plans and is estimated to be between 2% - 4% of the premium.
- With a prescription carve out, it provides the client two independent sets of data to analyze their overall health care package and compare and contrast the utilization trends and patterns reported by each for verification and validation of one another.
The client can consolidate and offer one prescription benefit to all employees, regardless of the medical program. With a carve out, the medical benefit does not have to dictate the prescription coverage that is provided.
As always, EHIM encourages all clients to consult with their benefit advisors on how various aspects of the Affordable Care Act (ACA) may impact healthcare offerings. EHIM is here to support and work with the agents and their clients regarding the different healthcare changes and mandates taking effect over the course of the next couple of years. We are dedicated to providing and designing new long-term healthcare solutions for our clients that will increase cost savings as well as the overall health and wellbeing of our members.
Company Promotes Self-Funded as Viable Healthcare Option for Employer Groups