Focus on the Self-Insured Employer

Simplicity Health Plans offers the self-insured Employer a comprehensive Consumer Directed Health Plan solution to the spiraling costs of health care. We combine the benefits of CDHP + Self Funding + Simplicity's Point of Service Payment System (POS) + Tax Savings

We offer a fully integrated, ERISA compliant health plan complete with HSA management, medical claims administration, TPA functions, pharmacy, dental & vision, stop loss reinsurance, COBRA, real-time Utilization Review, Medical Case Management, Health Coaching, Comparison Shopper, Wellness & StayFit programs, "Health to Wealth Financial Calculators" and a host of real-time online tools for Providers, Employers and Members with an emphasis on educating the insured and their dependants. We streamline processes and eliminate the current problems with High Deductible Health Plans with HSA. Call us today for more information and pricing.

Emphasis on the Full Replacement HSA

Simplicity’s primary emphasis is on full replacement, HSA programs. Philosophically, we believe that consumerism will not become a reality until all employees have skin in the game – their own skin.

Some have stated that CDHP programs, namely HSA’s, will unfairly burden high utilizers. In reality, claims statistics show that on average, 80% or more of a typical group’s Members will accrue a positive HSA balance over each plan year. Likewise, high utilizers are, in nearly all cases, no worse off in net out-of-pocket costs (within an HSA plan) compared to traditional PPO plans with co-insurance.

Simplicity’s integrated Line of Credit goes a long way towards addressing objections to higher, HSA deductibles. This feature provides Member families a financial backstop should they incur any major claims before their HSA is fully funded.

Based upon our Employer customer needs, we can also tailor an HRA program as a transition into an HSA and a traditional PPO plan to compliment a Simplicity HSA offering.

“Follow-Up Free” HSA Administration

Simplicity’s HSA account is a virtual banking relationship that pays claims directly to the Provider on behalf of the Member.

Our system eliminates a debit card and therefore the need for Members to follow-up and complete an HSA medical claim payment – often weeks after the appointment.

Simply put, we offer the most “Member Friendly” HSA available in the market. There is no more efficient system to pay claims.

No Fee, Interest Bearing HSA Accounts

Eliminating debit cards and checking accounts also eliminates the fees required to keep HSA accounts open and process transactions. These savings are passed directly to Members in no fee, interest-bearing accounts.

Members may easily access their HSA funds to pay for qualified out-of-pocket expenses that may not be covered under the plan. A phone call or an internet request is all it takes. It's that simple.

Investment options are also offered once account balance thresholds have been established.

Integrated Advance Account

Simplicity’s HSA product includes an integrated Advance Account for all Members. This feature covers the difference between the accrued HSA account balance and the member's deductible in the event the member has a bill that is covered on the plan. Members pay back Advance Account amounts using pre-tax money from their HSA accounts.

Access to an integrated Advance Account gives Members the confidence that they can join a high deductible, HSA program without a major impact to their monthly budgets. Enrollment in HSA programs will increase when Members have this type of safety net available.

Integrated Medical and Financial Auditing

Unlike debit card based HSA programs, Simplicity’s Member web portal provides both the medical and financial records of each transaction – on a single screen.

Members can easily audit their medical claims using this combined accounting system. They can communicate directly to the Provider via secure e-mail connection in the event there is a problem with the claim.

Medical Education

Simplicity’s Member web portal provides a comprehensive medical research library geared to educate Members on various health conditions.

“Member Nurses” are also available to answer basic, condition related questions and steer Members to additional resources as may be required. Our Nurses will also customize information packages on conditions as Members indicate a need.

Pricing & Quality Transparency

Awareness of the costs of medical and pharmacy services is a key component of consumerism. With “skin in the game”, educated Members will make better, more value-oriented decisions regarding the purchase of health care.

Simplicity offers Members pricing data for medical services based on regionalized norms. Qualitative results for hospitals and Providers are also available through a combination of publicly available data and Member surveys.

Pharmacy expenses continue to rise at an even faster pace than medical services. Arguably, there is more opportunity to “shop” for prescription drugs than medical procedures. Simplicity’s Member web portal offers exact pricing of prescription drugs covered under the plan. Members have the opportunity to review therapeutic equivalents to their prescribed drugs and work with their Providers to achieve the best medical outcome for their health care dollars.

“Comparison Shopper”

Simplicity Health Plans’ services were designed around the lowest common technical denominator: the telephone. If a Member learns only one thing in our plan, it would be to “Dial the Comparison Shopper” and ask for advice over the telephone.

The “Comparison Shopper” is a Registered Nurse in our call center with access to all Simplicity Member web portal tools. In the event a Member has no internet access or they desire a “live person” interaction, all they need is a telephone and the Comparison Shopper will provide the requested information immediately. It's that simple.

Using the Comparison Shopper, it is even possible to call from the Provider’s office, via cell phone, and ask for the pricing of a medical procedure or a list of therapeutically equivalent drugs to discuss with the Provider.

Customized Health Coaching

Members who desire to focus on wellness have the opportunity to develop customized plans using a Simplicity Member Nurse. Our StayFit plan can accommodate every employee helping them to stay healthy and able to work.

Starting with a detailed Health Risk Assessment, the Member will identify areas for potential improvement. They may then work with the Member Nurse to tailor a program to achieve their goals based on their individual lifestyles and needs.

An ongoing health coaching relationship can be developed either on line or via the telephone to provide advice, support and encouragement for the improvement of the Member’s health.