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Self-Funded

A Breadth of Benefit Services

Choices and customization are the benefits of self-funding your company's health insurance plan.

MedCost works with you to strategically deliver the plan for your workforce. There’s the care, then there’s the administration of that care. MedCost is here to help with both. Some of our advantages include:

  • Plans tailored to your unique population

  • Substantial savings through our provider network and efficient claims processing

  • Customized analytic reports for clearer decisions and results

Administration

As a third party administrator (TPA), MedCost is here to provide you with accurate, cost-effective and timely administrative services. Not only are we committed to service excellence, we are nationally recognized for best-in-class claims operations and health care administration. We have the experience and expertise needed to handle all your health care claims administration.

  • Online Benefits Enrollment Platform

    Intelligent, fully automated enrollment software features intuitive self-service with decision support tools. MedCost has partnered with bswift to offer an integrated platform that streamlines employee alerts, benefits enrollment, benefits administration and HRIS functionality. MedCost will assist with the set-up and configuration, and we have a dedicated staff available for support.

  • Claims Processing

    Fast and accurate electronic claims administration with 98% procedural and 99.7% financial accuracy. We provide a single payer model—meaning that with MedCost, you receive consistency with ID cards, EOBs and customer service, member-level eligibility, electronic funds transfer, electronic claims filing (99%), claim status inquiry and authorizations.

  • COBRA

    Our expertise can help you avoid costly mistakes in interpreting complex COBRA laws. Our dedicated compliance team constantly monitors the changing laws to provide ongoing administration that is accurate and efficient.

    You and your COBRA participants can stay informed with online access through the use of industry-leading COBRA administration software. View your monthly and quarterly reports online, and generate real-time reports as needed. Participants can view account(s), track premium amounts and due dates, see premium postings and set up premium payments via recurring bank draft.

    All you need to do is report any new hires, changes in status and terminations—and let MedCost Benefit Services handle the rest. You’ll receive notification of an online monthly summary of activities, along with a single check that combines all of the premiums collected. At every step along the way, MedCost is available to handle any questions for you and your COBRA participants.

  • Cost Containment

    With the cost of health care continuing to rise, MedCost recognizes the importance of effective cost containment strategies. Our subrogation services, out-of-network fee negotiations and payment integrity program help to ensure that our clients’ health plan costs are in check.

    We manage all the details of subrogation for our clients, including contacting at-fault parties, insurance adjusters and personal injury attorneys. Our service includes providing any documentation from the investigation and collecting the amount owed, which could include filing a lawsuit or using a collection agency. We work with highly experienced attorneys to resolve issues as quickly as possible on our clients’ behalf.

    Through strong relationships with national and regional networks, MedCost can help clients realize additional savings on their out-of-network claims. Effective fee negotiation can result in significant cost savings.

    Validating payment integrity to protect and secure savings for our clients is also part of our administration. Our payment integrity program confirms that provider services are billed appropriately, according to industry standards, before any payment is issued. As part of our pharmacy administration, this program helps detect patients who obtain multiple prescriptions for narcotic painkillers from different doctors.

  • Analytics and Reporting

    Timely, customized reports based on advanced analytics are provided to employers to show a true picture of health results and costs. Comprehensive reporting provides drill-down analytics that allow you to compare your employee utilization with others.

    Benefits of advanced analytics include:

    • Accurate reports

    • Normalized measures based on industry-accepted tools of evaluation yield best results for your employees

    • Maximized outcomes

    • Your company may rate higher on the Analytics Sophistication Scale and outperform industry peers

    • Healthier employees

    • Potential risk for developing conditions can be identified and mitigated

    • Lower costs

    • Wise management of expenses creates a sustainable long-term cost trend

  • Underwriting Service

    We provide full support in arranging stop loss insurance which protects your company from expensive claims. We have one of the highest ratings from Optum Stop Loss giving our clients larger discounts.

    As administrator of your stop loss coverage, we review your coverage to ensure that you will not face any unexpected exclusions, gaps in coverage or claim denials. We look to find the ideal policy that will have limited exclusions or better yet, mirror the health plan’s Summary Plan Description (SPD). A good stop loss carrier offers financial stability, the ability to be efficient in paying claims and an ease to doing business.

Customizing Your Care

You need choices in your health care benefits. MedCost delivers and administers solutions for employers from a wide range of industries and non-profits. Here are some of our comprehensive services we can administer on your behalf. MedCost also works well with other providers if your company would prefer to work with multiple benefits providers.

  • Care Management Options

    We see our role as helping you give employees what they need to be their best selves. Our involved and individualized care supports the sick and the well—from providing treatment options for a complex condition to a lifestyle coach to help reset and maintain life’s balance.

    We can help administer benefits to help your employees be their best selves whether they are Healthy & Well, have Acute medical needs, are At-Risk/Rising Risk or have a Complex condition.

  • Flexible Spending Accounts

    Both employers and employees benefit from this pre-tax option. As co-pays, deductibles and the cost of childcare continue to increase, a Flexible Spending Account (FSA) is one of the best benefits an employer can offer. MedCost offers administration of two types of FSAs: one for health care and the other for dependent care.

    Strict IRS regulations apply to the administration of both types of FSAs, and mistakes are costly. MedCost handles all the details of FSA administration for our clients with accuracy and efficiency.

    A flex debit card is a convenient option to offer members participating in an FSA. The Flex Benefits Card can be used to pay for eligible health care expenses at thousands of merchant locations, including most major chain stores. Cardholders have secure, 24-hour access to account status, transaction detail and plan balance information through their member login.

  • Pharmacy

    The goal of any pharmacy benefit program is to control growing drug costs without compromising care. At MedCost, we work closely with our Pharmacy Benefit Management (PBM) partners to negotiate and design aggressive contracts that maximize savings while minimizing drug spend. Our Care Management team and in-house pharmacist collaborate with our PBM partners to identify and reduce pharmacy gaps in care such as medication adherence, brand to generic prescribing opportunities, drug administration site-of-care review and conservative therapy evaluation.

  • Dental and Vision

    MedCost can also provide a single source for the administration for other benefits such as dental and vision. Poor oral health has been linked to conditions such as strokes as well as heart and lung disease. Dental coverage is a practical and affordable enhancement to a self-funded employer’s benefit program. We take care of processing, paying claims and providing detailed reporting.

    Vision benefits have become a significant component of an employer’s overall benefits package. Eye care professionals can often detect and predict risk for diabetes, multiple sclerosis, hypertension, stroke and heart disease. Early detection of these and other conditions can help minimize financial impact on benefits costs.

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