While CHA America did not invent the traditional health insurance model, we did uncover its financial flaws. And we have reinvented a model that has removed the competing and misaligned financial incentives between plan components.
Quote Process & Underwriting
The quoting process is designed to be quick, easy, accurate, and secure for brokers as well as for their employers and employees. All data exchange and storage with CHA systems are SSAE Type II and HIPAA compliant allowing for secure digital transmission of paperless applications and PHI.
When an employer is ready to see how a CHA plan will work for them, we can generate manual quotes within 24 hours of receiving basic census/demographic information. When ready to apply for final rates, we will supervise the process to generate underwritten medical quotes which typically require medical applications from employees.
Our online application system streamlines the entire process for employers and employees alike. It allows both the broker and employer access for year-round employee communication, plan maintenance, and secured data reports.
CHA manages all components of the medical plan and continuously reviews performance of partners. Along with our selected partners, we act in a fiduciary manner to always serve with the client’s best interest in mind. Our Third Party Administrator (TPA) provides custom-built reporting packages to provide an assessment of the plan.
Benefit administration and single-source invoicing of all benefits are available through our tailored software platform. Services include:
- Claims payments, accounting, customer service
- Online services and monthly reports with easy access to plan information
- Simplified billing with one flat monthly payment including claims fund contribution, stop-loss insurance premium, and administrative services
- Administration of tax-advantaged options for HSA, HRA, and Section 125 Plans
- COBRA plan administration for medical, dental, and vision, regardless of carrier placement.
Our pharmacy cost control measures allow clients to maintain control of a growing share of medical spend. The CHA plan uses an evidence-based formulary, an exclusive PBM contract with proprietary specialty drug methodology, and is coupled with best price sourcing and transparent pass-through costs.
Using domestic pharmacies, we access a lower-cost class of trade for high-cost medications adhering to federal guidelines. With access to your pharmacy data, we can reprice pharmacy claims, pinpointing pricing irregularities with your current program. This data allows us to quantify potential annual savings.
Unlike a traditional PBM, ours is geared to clinical success of the client rather than financial success of the PBM. A typical PBM is paid a combination of disclosed and undisclosed revenue through sources such as spread pricing, re-packaging, formulary manipulation, and rebates.
The CHA underwriting and reinsurance team works collaboratively to precisely measure actual risk, not only at initial implementation but also during subsequent renewals.
Underwriting is customized with our online medical application with the goal of providing competitive rates, reduce plan costs, and sustain a valued, affordable plan for years to come. Our partners are aligned with our cost-management methodology, allowing for much reduced stop-loss premiums.
Bringing together the reinsurance team, pharmacy benefit management program, provider access group, and online application system, we have an in-depth understanding of overall risk to the plan. The result is the most accurate and precise rates as possible. Employers will be less likely to waste dollars in excessive stop-loss premiums or tie up miscalculated claims funds, making subsequent year renewals much more predictable.
CHA plans are customizable and can use a variety of provider networks and alternative repricing strategies. Networks may include national, regional, proprietary private networks (CHA developed), or direct primary care (DPC). Pricing strategies may include referenced based pricing opportunities using Medicare reimbursements as the baseline.
Chosen solutions will be determined by geographic location, employer and employee tolerance for change, and eagerness to achieve savings. Network choice is a significant risk measurement factor for underwriting and renewal, so we engage our reinsurance underwriters in network selection.
By effectively managing claims payment, we are able to realize money saved directly to a plan’s claims fund. This leads to a more accurate calculation of medical spend and a better chance there will be claim dollar reductions and potential refunds at the end of the contract.
We believe so much in a telemedicine offering that we provide it with all standard level premium plans at no additional cost to the member and no claim liability for the plan. Having immediate and no-hassle access to medical professionals, we help employers redirect claims, reduce sick days, increase productivity, and improve worker morale.
Through a mobile platform, employees have access to talk to a doctor 24/7 by phone or video, shop prescription costs, find pharmacies nearby, access medical experts, or get second opinions. Our telehealth app allows employees to skip expensive trips to the ER and talk to a physician who may diagnose and recommend a treatment plan if necessary, including calling in prescription drugs or ordering lab tests. Instead of asking HR, employees are empowered to find many answers on their own.
Chronic Disease Management
Our chronic disease management program begins by identifying conditions that add significant claim costs within a health plan. Each member is offered an opportunity and incentives for a one-on-one consultation with a certified clinician to help manage their condition.
With participation, we see improved member health, which typically results in reduced overall healthcare spend with an ROI of 3:1 (savings of $3 for every $1 invested).
Our programs are designed to help plan sponsors manage costs by reducing the risk of complications for common chronic conditions and comorbidity, including diabetes, cardiovascular disease, asthma, depression, anxiety, and related disorders. We target conditions within your population that are primarily dependent on the proper use of medications, adherence, and monitoring of frequently complex combinations of drugs.
HR Consulting Services
HR is a critical part of any company and employee benefits program. Recognizing the challenges involved and the opportunities for both risk mitigation and education are at the core of our service offering.
Our HR resources are designed to help clients mitigate people-centered risks. The complexity and constant change tied to people risk issues in the workplace create a burden many companies can’t handle. When using our platform, you will have services to help manage those risks with an end-to-end approach to HR, compliance, and risk management.
We help employers manage risk before, during, and after it’s exposed. We help you minimize the risk and maximize the engagement by asking situation-specific questions and getting expert answers, accessing abundant HR and compliance resources, and providing your team with online training courses.
Our goal in working with our broker partners is to help them, and their clients, find new levels of success. With efficient use of tools and communication, CHA helps our brokers excel.
We provide custom marketing materials to help you effectively tell the story of why a CHA America plan is right for their organization and team members. And we follow through in post-purchase with communication tools for plan members.
Our online underwriting process brings a new level of efficiency. We teach you how to use it and help you through the process with preparation, monitoring, and delivery to underwriters. We then lead you through pharmacy audits and a final results presentation to quantify hard pharmacy savings for your client.