Plan Funding Options Overview
Securus Benefits brings unique specialization in Level Self-Funded and traditional partially Self-Funded health plans. A significant cost driver in both Level Funded and Self-Funded health plans is Reinsurance or Stop Loss coverage. Securus Benefits brings unique expertise and value to this critical component.
- Unique Reinsurance relationships
- Unique Reinsurance contract provisions
- Unique underwriting flexibility – we understand that an employer transitioning from a Fully-Insured plan to Self-Funded plan has limited access to claims data.
Unlike the Fully Insured or insurance carrier driven Level Self-Funded products, the Securus Benefits Model is designed to maximize plan savings at the employer level through innovative plan designs and state-of-the art cost containment strategies.
Plan Administration Overview
Securus Benefit’s Technology platform allows for the flexibility of various plan design approaches.
Implementation
- Dedicated Securus Management Team
- Self-serve onboarding
- Electronic onboarding forms
Software Services
- Member portal
- Employer HR portal
- Manager portal
- White-labeling optionality
Vendor Orchestration
- State of the art EDI engine, custom routing
- Scheduled auto-sends to vendors
- Compliant sharing of real-time data
Data Processing Services
- Configurable medical and pharmacy claim processing logic
- Claim repricing
- All data accessible to customer, available via portal and API
Billing Services
- Creation of FBO accounts for employer
- Connect-a-bank account technology
- Auto-invoicing with line-item details
- Auto-distribution of funds to vendors
Claim Payment Technology
- Creation of virtual credit cards, connect to the claims fund, for pre-adjudicated payments
- Provider payments
- Real-time member payments
Adjudication & Communication Technology
- Custom adjudication rules
- Provider claims communications (EOPs)
- Member communications (EOBs)
Support Services
- Asynchronous and synchronous member support
- Member care navigation and steerage
- Client account management
Additional Administrative Support
- Print and mail of member ID cards
- Print and mail of welcome resources
- Employer compliance forms
- COBRA administration
- Stop Loss procurement
- Stop Loss claim filing
Custom Services
- Reporting exports
- Dashboards
Provider Networks
National Carrier Networks
Regional PPO Networks
Direct Contracted Networks
Reference Based Pricing Models
Prescription Benefits Overview
Elimination of egregious “spread pricing” as a profit center – common among insurance carriers, traditional PBMs and TPAs
- Proactive formulary management to combat increasing costs of specialty and brand name drugs
- Engaged Health Management for medication adherence
- Preventive Care and Over The Counter drug lists
- Specialty prescription management
- Alternative Drug Product Sourcing
Wellness Management Overview
We offer programs to meet your specific wellness goals.
- Plan Incentives are Integrated within the Medical and Prescription Plans
- Plan Rewards Achievement Rather than Just Participation
- Participant Condition Specific Digital Monitors
- Proactive Large Case Management, Utilization Review and Pre-certifications
- 24/7 Nurse Line
- Wellness Lifestyle Coaching