When offering health benefits to employees, employers face the risk of experiencing high-cost claims if plan participants are diagnosed with a serious illness or disease. Self-funding allows the flexibility to plan for these situations … proactively. In this example, Tom Doney of Cypress Benefit Administrators shows how implementing two innovative benefit solutions – organ transplant carve-out insurance and cancer care management – made a huge difference for one client. See how these benefits saved the firm more than $2 million in claim costs and led to healthy outcomes for plan members. Read on for the full article.
For more information or to contact Cypress Benefit Administrators, visit www.cypressbenefit.com or call (877) 236-0844.
Forward-Thinking Employee Benefits Lead to More than $2 Million in Savings and Healthy Outcomes for Plan Members
One of Cypress Benefit Administrators’ clients* had always offered comprehensive health care coverage for its employees, basically covering all expenses except for a small deductible. And while the architectural/engineering firm was not struggling financially from this burden to date, Cypress knew that, statistically, there was a strong chance that a plan participant could be struck with a serious illness requiring long-term treatment that could wreak havoc on the firm’s finances.
As a way to proactively address this vulnerability, the third party administrator (TPA) strongly recommended that the firm re-consider adding two benefit solutions to its self-funded plan. The strategy behind incorporating these employee benefits – organ transplant carve-out insurance and cancer care management – was simple. Not only would it protect against the high-cost claims the associated medical conditions can often lead to, but it would also ensure that plan members who may face a transplant or cancer diagnosis have access to the very best care.
A year or so after implementing these benefit solutions, the firm experienced two transplant cases among its group of plan members. One involved the need for bone marrow and the other was related to a pancreas transplant.
The treatment for both members centered around advanced procedures that come with very high price tags – unexpected expenses that could be financially devastating to a company. As the claims came in, the charges for the transplants and additional care amounted to more than $2 million. These costs were all covered through the carve-out benefit and didn’t come out of the firm’s plan funds. On top of that, the plan members received top-notch care from specialty providers at renowned facilities.
It was a similar situation with the cancer care program.
A plan participant was diagnosed with cancer after the benefit solution was integrated into the firm’s self-funded health plan. Upon diagnosis, the member was connected to an experienced cancer care team, and after working together, it was decided that a new, proton beam therapy would be the best course of treatment.
As with the organ transplant insurance, the cancer care program covered the claim costs related to this state-of-the-art treatment. More good news? The plan participant is now cancer-free.
Cypress is a TPA that continues to show how a forward-thinking approach to employee benefits like this can help employers build customized self-funded plans that both contain costs and offer exceptional care.
*Company identity withheld for patient privacy purposes.