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In the economic atmosphere of rising premiums and decreasing benefits, one third party administrator, MBA Benefit Administrators, is transforming the healthcare landscape nationally, in part due to their partnership with ELAP, a medical bill audit and repricing company which provides fiduciary protection to its clients.

While across the nation ACA regulations have catapulted a double or triple increase in premium costs, MBA’s medical benefits platform, The Open SolutionTM, is consistently seeing  decreases in annual medical plan spend. CEO Phyllis Merrill describes their experience with 2015 plans, “Every renewal in our book of business that uses our elap audit and repricing method went down!”

MBA has served thousands of members over the course of 30 years, however, with the addition of  ELAP’s auditing, repricing, and fiduciary protection, unexpected results have come to fruition in reducing  the bottom line for employers, including corporations, municipalities, school districts, and Indian Tribes. As part of a multi-pronged cost savings strategy, ELAP provides a formula that guarantees the provider a reasonable profit, while keeping in balance the actual costs of doing business, to prevent runaway profit garnering. In the case of balance billing directly to the recipient of medical care, fiduciary protection steps in to mitigate legal action. Since 2012, ELAP’s legal team has successfully set precedence in favor of their audit and repricing structures.

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Here are a few examples from MBA’s clients in 2015 when ELAP was used as part of The Open SolutionTM plan.

  • One client reduced their maximum liability by $1,000,000.
  • Several broker’s entire block of business received decreases in plan costs!
  • One family welcomed a new baby a bit early. Their $1.3 million NICU claim was satisfied, using the auditing and repricing method provided through ELAP, with a payout of only $187,277.33.

 

As you can see, changes are being made, one employer, one broker, and one family at a time. The impacts are incredible!

So, what’s the strategy behind these remarkable and innovative savings?

Before we go into the details of how miracles are being created today, let’s look back to the start of egregious cost growth in the medical industry.

The first medical insurance was an Indemnity Plan that paid a set amount for a specific type of medical event. Then came Major Medical, which at the time seemed revolutionary, and gave people a way to cover the cost of catastrophic care for the price of a monthly premium. It was up to the insurance company to pay for medical care. Being an informed and responsible consumer was now not possible because prices and discounts weren’t disclosed before making a decision about care received. This created a disconnect between the billing and the payment of the bills. The disconnect is even greater now that it has become a right to have all major medical expenses paid no matter the cost.

Insurance companies then began negotiating with certain facility groups to gain discounts in exchange for driving the patients of an insurance plan to that particular facility. Don Merrill, Founder of MBA Benefit Administrators, Inc. tells of his experience when asked to consult with a large hospital system in Texas. In the early 80’s, when the preferred provider networks were in their infancy, Don and a protégé were contracted to assist in setting up a provider network. It was a complicated process and in the end the hospital decided that they would give a 20% discount to those who used their network. In order to do that, they increased the billed rate for services by 20%, and only those who were part of the network could enjoy the discount.

The idea of discounting as a percent off of retail is genius because if the hospital needs more money they simply increase the billed charges and leave the discount percentage the same. This approach is widespread today. Furthermore, in exchange for discounts, most PPO contracts do not allow payers to audit a hospital bill.

...with powerful health care and claims management systems to save them money.
We believe your investment in a health plan should be treated like any other aspect of your business, with upfront knowledge of the costs and all attempts to weed out waste. MBA saves employers more than nickels and dimes with many methods of management, including: Metrics Based Pricing: Why rejoice over a 30% discount on a claim that is 1000% too high? Metrics Based Pricing reduces claims to a “cost of service + reasonable margin” level by auditing claims for unfair markups and inaccurate or fraudulent billing. This results in an average $1500 per employee savings – AND WE DO IT WITHOUT RESTRICTIVE NETWORKS! Medical Management Services: Proven to reduce hospital admissions and the average length of stay. HealthSteps™: Wellness plans and initiatives that do make a difference in the overall health of your workforce and drive down health claims. Prescription Benefit Management: With an average reduction of 9.4%. Internet Prescription Bidding: Allowing employees to save up to 87%. Actuarial Projecting: The projection of benefit costs and savings is one of our underwriting core competencies. Go ahead – suggest benefit changes, add or drop a plan component, change eligibility: MBA will accurately determine the financial impact on the plan and offer suggestions to tweak the benefits to suit your objectives. We offer the facts then you call the shots.
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We're neighbors you can talk to...
Where else can you get a direct line to a claims adjudicator, plan manager or even the President of the company? Only at MBA Benefit Administrators. We’re the big third party administrator for health plans with personal service that you can only wish others would provide. Like talking to a friend over a fence, we have that neighborly feel…but we provide world class advantages.
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With “outside the box” flexibility in health plan administration…
Since 1987 MBA Benefit Administrators has successfully served large and small employers, public entities, associations, tribal nations, school districts, non-profit organizations and insurers. We have the capability to administer anything from single-plan 25-life groups to complex employee organizations with multiple medical, dental and vision benefits or employees in multiple states. We also provide a wide array of ancillary services such as COBRA and HIPAA administration and HSAs. When you discover:

  • The depth of our experience
  • The flexibility we offer in benefit design
  • Our commitment to technology to make your life easier
  • Our can-do attitude toward service

 

…we’re confident you too will see why MBA is a national leader in third party administrative healthcare benefits.

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…and we prove real solutions do exist for escalating healthcare costs.
We’ve received national kudos for our multiple, proven strategies which reduce claims and plan costs without harmful benefit reductions for our clients’ employees. Proof of MBA’s effectiveness in this is in the numbers. Our clients see:

  • An immediate average reduction of up to 25% in maximum health plan costs the first year,
  • Flat renewals after that, and because of this and our commitment to impeccable service…
  • Our clients remain with us an average of 12 years…an unheard of accomplishment in the health insurance industry.
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…and state-of-the-art technology for painless administration and integration of services, we make your life easier.
No one thinks about making your life easier and more efficient than MBA Benefit Administrators. Our technological investments are totally integrated across services so that employees and employers – with HIPAA-compliant and appropriate need-to-know safeguards – can view at a glance their standing for benefits, claims, plan reporting and other services. These advancements provide:

A Comprehensive On-Line Enrollment Wizard: Employee self-enrollment or HR department enrollment methods, including ancillary program enrollments and billings.

HR On-line Capabilities: View, adjust and approve on-line employee eligibilities; check claims status, print reports and plan documents all from one place.

Multiple Employee Access Channels: Employees can view on-line their claims status, eligibility and account balances of reimbursement plans such as HRA, HSA, Flex and Executive Reimbursement plans. In addition, we offer all employees our MBA App, where they can:

  • Carry a virtual ID card,
  • Check on the status of a claim,
  • Submit secure documentation to MBA,
  • Contact our support team,
  • …and more!

On-line Document Management: In one place view specific documents such as:

  • Plan Documents
  • Temporary ID Cards, and
  • Employee Communications and Forms

HSA Services Integration: MBA seamlessly integrates HSA plans with HealthEquity Services. Claims information is electronically transferred from MBA’s claims system to HealthEquity employee accounts. There is no need for paper claim filing or second-guessing the eligibility of expenses. Even employee eligibility is updated through MBA data feeds.

HRA Reimbursement Plans: MBA’s administration processes allow clients and their participants to rely on accurate and timely processing of reimbursements. Eligibility, billing and remittance of claims, integrated scanning and storage allow for real-time remote access.

Section 125 Flexible Spending Plans: MBA Benefit Administrators coordinates with employers to offer Section 125 Flexible Spending administration and help employees save money on medical expenses. Providing this benefit for your employees is like getting a 30% discount on Medical Premiums, uncovered medical expenses and dependent care.

COBRA Administration: MBA Benefit Administrators can handle all of your COBRA requirements. We will mail and track notifications, coordinate COBRA payments, receipts and reporting and ensure claims match “paid through” dates, plus give you on-line access to all activities.

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At MBA employers are cared for too…
MBA goes the extra mile to ensure that as an employer your health plan does not complicate your life. We give you things like:

  • Business intelligence for advanced reporting and critical analysis of your plan’s performance, costs, payouts, claims analysis and large claims submitted for insurance.
  • Billing and Funding services integrated with enrollment, customized to your specifications and handled electronically.
  • Account balancing systems produce cost accounting reports and perform bank reconciliation activities, available for review at any time.
  • And the ability to review multiple reports regarding your plan; check registers, active employee reports, YTD recaps, claims reviews and lots more.
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1. It’s an “easy in”.
Almost every larger employer (50+ employees) annually shops their company’s health insurance. Rapidly rising rates and diminishing benefits have traditionally caused them to shop this aspect of company insurances more than any other.

With very little work this easily opens a lot of doors you wouldn’t otherwise get through. Furthermore, local employers like local expertise. They welcome the neighborhood broker who can answer service questions or help with the employee enrollment process. All you have to do is be ready with competitive products at the appropriate time.

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2. Group health opens the door to other profitable sales.
There are a lot of needs that are begging for solutions within the corporate world, whether that world employs 50 or 5,000. CEOs and business owners want to retain key employees or prepare themselves for the future. Employees need guidance during life changes, such as an impending retirement, the buying of a new house or the birth of a child.

If you wander the halls of your group clients under the guise of service, you’ll be surprised what you uncover and how much more you can sell – just because you’re accessible.

With very little work this easily opens a lot of doors you wouldn’t otherwise get through. Furthermore, local employers like local expertise. They welcome the neighborhood broker who can answer service questions or help with the employee enrollment process. All you have to do is present your own insurance lines and solutions – the same products you currently sell – when the need arises…and it will!

• Key Person Insurance
• Buy/Sell Agreements
• Deferred Compensation
• Disability
• Estate Planning
• Retirement Plans
• P&C Products – Both Business and Personal

…the list could go on and on. MBA doesn’t provide these products, but with the group health business already captured you’ll be in a position to favorably present your own policies and services.

Each easy cross-sell has the potential to be very profitable as now you, the group health broker, are a trusted resource. Make one sale and it won’t be long before everyone wants to talk to you just because you are the tacit face of insurance within a group client’s company.

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3. The larger group health market offers long term financial stability.
It is a proven fact that the more products you have in place within a group the less likely it is that some other broker will be stealing your business. With a competitive group health plan, a passion for service and additional products in place, employers think twice about switching brokers. MBA, for example, has an average client retention rate of 12 years.

Group health is rarely a stand-alone product. With today’s tax codes a group health plan almost always immediately calls for HSAs, COBRA administration and the like. In addition you’ll be finding a lot of ancillary sales.

That’s a good, stable building block for a broker’s income. Year after year the same commission is paid the broker and year after year the deep well for cross-sells keeps on giving.

In the meantime, adding new groups just keeps the broker’s income growing to the upside.

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4. Commissions are recurring and high, perhaps higher than any other product line.
To put things into perspective:

• What’s the average commission on a home owner’s or auto policy?
• How often do you dig up on your own a million dollar life policy or high 6-figure annuity?
• How easy is it to scrape up new business?

Contrast that with the group health broker. MBA, for example, pays brokers handsomely (on average $25 per employee per month) for every group they sign up. On top of this are your multiple cross-sells for several product lines. With a good base group health income and constant cross-sells, a commission from one group can rack up quickly.

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4. Commissions are recurring and high, perhaps higher than any other product line.
To put things into perspective:

• What’s the average commission on a home owner’s or auto policy?
• How often do you dig up on your own a million dollar life policy or high 6-figure annuity?
• How easy is it to scrape up new business?

Contrast that with the group health broker. MBA, for example, pays brokers handsomely (on average $25 per employee per month) for every group they sign up. On top of this are your multiple cross-sells for several product lines. With a good base group health income and constant cross-sells, a commission from one group can rack up quickly.

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