Greg Hummer, Gregory Hummer, Simplicity Health, Simplicity Health Plans, CDHP, Consumer Directed Health Plan, HSA, Self Funded Small Group

A Solution to America’s Healthcare Crisis and What It Can Mean to Your Business

Webinar - Simplifying the Healthcare Payment System

Q: What are the underwriting requirements for a small group (i.e. - types of medical questions)?
A: Must complete a simple medical questionnaire, have at least 2 unrelated employees, have 75% participation after wavers

Q: What happens if a covered person gets the cash advance and then leaves the group before an HSA payment can cover it?

A: Cash advances are not distributed directly to employees. Advances are only paid directly to the provider and then only if a covered service under the plan and initiated by the Simplicity system and not the member.

Q: Can an HRA be used rather than an HSA account if an employer prefers?
A: Yes we offer HSA and HRA and a hybrid of both.

Q: I want to see my own doctors. what if they don't agree to your payment amount? Can I just pay the extra if he doesn't budge?
A: You can see you own doctor and convince him to take what you will pay OR if he won't budge then re-pricing is defaulted to the PPO and the provider would be paid according to the PPO rate.

Q: What does it mean to default to ppo, what cost implications to employee?
A: Generally the PPO contracted rate is more than the Simplicity price, however the provider will have to wait for his money and may have to bill you just like any other self pay patient that has a high deductible health plan.

Q: What information is required to obtain a quote?
A: Name or number, age, gender, home zip and coverage type EE, E+C, E+S, Family Once you are signed up with Simplicity you can access our web site for online instant QuickQuotes.

Q: What PPO do you use?
A: We have most major PPOs throughout the 50 states, an example would be First Health, Beechstreet, etc.

Q: Is claims data required?
A: Only if the company is already self funded OR if it is easily available for a fully insured employer. Claims data would be required for an employer that is already self funded that would like a quote on stop loss.

Q: Can we get access to the PowerPoint?
A: Yes.

Q: What is the website?
A: www.simplicityhealthplans.com

Q: Where can we get summary of the benefit plan?
A: By calling Deborah Wolfe at 336.813.0180

Q: How is Simplicity paid?
A: On a PE/PM administrative basis.

Q: Does the employee negotiate the price of service with the provider pre-service or does Simplicity adjudicate the costs post service at point of sale?
A: The member can negotiate pre-service. We provide tools for cost estimation. However, Simplicity automatically adjudicates, clinically edits and re-prices the bill instantly at the point-of-service and offers the provider immediate payment for a fair discount.

Q: What is your provider network acceptability? What if the consumer goes to their doctor and they don't know how to access your system?
A: We use major networks across the US. Access is via the Internet and directions and easy directions are on the back of the card. we made it very simple.

Q: You mentioned fees/commissions to brokers. How do contract and pay brokers?
A: Deborah Wolfe at 336.813.0180 can work with you or your agency to get you signed up. This webinar was Step 1. We have another 30 minute Step 2 & 3 combined webinar that goes into more depth about the technology, self funded plan and selling the services. We have an agreement that needs to be signed, after which we give you a userid and pw to the QuickQuote site that will enable you to enter your census data and get an instant QuickQuote. All necessary forms and marketing material can be downloaded from the sales website after your agreement is signed. We pay a percent of the total aggregate premium for servicing and implementing the program at an employer/client. We pay a pe/pm amount for existing large self funded groups that would like to go full replacement CDHP on the Simplicity platform. Any size company is possible. We are currently talking to companies with 20,000-50,000 employees.

Q: Can you elaborate on your employee education program? What education program or collateral materials do you offer in support of HR?
A: We have a complete CD learning tool and a website that is intuitive. The website has many easy to use tools including a pricing Blue Book for cost estimation by zip code. Each member receives a folder with printed material and a CD. Members have unlimited telephonic access to health coaches, UR and Medical Case Management nurses in real time.

Gregory J. Hummer, M.D.
Simplicity Health Plans
Consumer Directed Health Plan (CDHP)
CEO
Cleveland, Ohio
216.367.3081