IncentiCare Preventive Health Management IC

 

BeniComp is excited to work with Agents and TPAs on a solution that identifies health risks and proactively addresses the root cause of claims.

 

 

IncentiCare Addresses Two Major Issues

 

IncentiCare addresses two issues simultaneously that have plagued employer groups for years:
rising employee deductibles and increasing healthcare claims linked to chronic disease.

 

rising deductibles chronic disease

 

 

 IncentiCare tablet phone computer

Empower Your Employees

With thousands of dollars in rewards, big incentives means big participation. 

 

IncentiCare allows employees to control their own deductible by earning significant rewards linked to health results. Outcome-based deductible incentives are placed on five health biomarkers in the blood that are controllable through lifestyle: 

  • Body Mass Index (BMI)
  • Blood Pressure
  • Blood Glucose
  • LDL Cholesterol
  • Tobacco Use

 

The plan’s unique filings make IncentiCare the only product that can offer thousands of dollars of potential earned deductible credits.

 

  

Overview | Outcome-Based Deductible Incentives | Preventive Health Management | Cost Structure | Implementation 

Overview

IncentiCare is a supplemental health plan that works with current self-funded clients, and employer groups transitioning to self-funded plans. Unlike other wellness products that have a 25-35% participation rate, IncentiCare achieves an average of 96% participation in annual health screenings by offering large, outcome-based deductible incentives. Employees are able to earn thousands of dollars toward lower deductibles by simply participating in a health screening and meeting screening goals.

The IncentiCare plan is backed by a Preventive Health Management program that uses innovative health technology and health professionals to provide participating employees and spouses with the necessary tools to accomplish lifestyle changes.

  • At-risk participants are identified through a deep data analysis of their blood work and claims reporting (if available).
  • Proactive health coaching is used to engage at-risk participants and drive healthy lifestyle choices.
  • Functional Medicine protocols are used to identify the root cause of claims, as opposed to traditional "diagnose and prescribe" methods, and eliminate costly chronic disease medication as well as future claims.

 outcome based deductible incentives phoneOutcome-Based Deductible Incentives

Most wellness add-on programs have a 25-35% participation rate, unintentionally targeting employees who are already healthy, and use gift-certificates or limited cash-based incentives. These methods result in added expense with little to no ROI. IncentiCare uses the deductible to offer large, cost-effective rewards on five health biomarkers directly affected by lifestyle:

  • Body Mass Index (BMI)
  • Blood Pressure
  • Blood Glucose
  • LDL Cholesterol
  • Tobacco Use

For example, let's say employees start with a $5,000 deductible plan. By meeting biomarker goals, employees can lower their deductible by three thousand dollars and earn a $2,000 deductible plan. Because the large incentives are built directly into the plan, IncentiCare achieves an average of 96% participation allowing health professionals to identify and address risks on nearly the entire population.

At-risk employees are motivated to make lifestyle changes necessary to earn a lower deductible for the next plan year. Large Outcome-Based Incentives ensure that employees make health improvements, unlike traditional, participation-based wellness programs.

Preventive Health Management (PHM)

Built on the premise that “knowledge is power”, PHM puts actionable health information in the hands of participants. BeniComp offers knowledgeable health professionals and innovative health technology to engage participants and provide them with the tools to control their health and live healthy lifestyles. PHM consists of four components:

  • Health screenings
  • Ongoing blood and claims analysis and reporting
  • Ongoing health coaching
  • Functional Medicine protocols and oversight

Health Screenings

Employees must participate in a health screening to qualify for a lower deductible. BeniComp coordinates the screenings, typically held at employer group sites for convenience and time efficiency. Large outcome-based deductible incentives are rewarded based on the results of 5 health biomarkers captured during the blood screening. Because the health screening is built into the design of the plan, IncentiCare achieves an average of 96% participation. This allows the Preventive Health Management team to identify and address health risks on the entire employee population.

BeniComp contracts with some of the top health screening companies in the country to provide quality phlebotomists, smooth implementation, and minimal employee issues. Each vendor is trained on the BeniComp screening protocols and credentialed based on professionalism, liability insurance, and references.

Blood and Claims Analysis

Strategic vendors are integrated into the BeniComp system so that laboratory results are received quickly, electronically, and securely. Upon completion of the screenings, BeniComp's health professionals analyze each participant’s blood data along with the corresponding claims data (if available), and provide individualized reporting to the participant along with aggregate reports to the employer group. Health-risk visibility is often a huge motivator for employees to seek out our Preventive Health team.

Functional Health Coaching

BeniComp’s team of Health Coaches proactively reach out to participants with out-of-range screening results to educate and discuss associated health risks. Participants are then offered one-on-one coaching sessions covered by the plan, at no cost to the employee, eliminating the tendency to not address health issues due to unknown costs. BeniComp's Health Coaches partner with your employees to assist them in making sustainable lifestyle changes that will positively impact their health. BeniComp’s Health Coaching team prioritizes your highest-risk employees in order to improve health, and prevent high-risk medical conditions from becoming chronic diseases.

Functional Medicine Protocols and Oversight

BeniComp’s team works with Functional Medicine doctors to create protocols and oversee difficult cases. At its core, IncentiCare works to uncover and address the root cause of health risks to avoid unnecessary claim costs.

Cost Structure

One of the unique features of IncentiCare is our cost structure. The cost of IncentiCare is broken down into four categories:

  • Fixed Premium
  • Variable Premium
  • Trend Reduction
  • Preventive Health Management Claims

Fixed Premium

The employer group is responsible for a fixed premium of $14 PEPM for employees who screened and earned credits. The TPA collects the fixed premium from the employer group each month and disburses the following funds to each party. A portion of the fixed premium goes to the TPA for administering the plan on behalf of BeniComp.

Variable Premium

The employer group is responsible for a variable premium equivalent to claims plus 6% as claims are incurred in the IncentiCare deductible space. The TPA collects the variable premium from the employer group and disburses the 6% for each month to BeniComp along with a claims file for all claims incurred during the corresponding month. The claims file is delivered via sFTP to BeniComp on the second business day of the following month.

Trend Reduction

BeniComp strongly believes that there should be no risk when implementing IncentiCare. The plan was developed to improve the health of your population and reduce claim spend. Therefore, BeniComp reduces admin fees and instead charges a 30% fee for the reduction of claim spend. If there is no reduction in claims accumulated towards the aggregate, then BeniComp doesn’t get paid a reduction fee. 

IncentiCare was built to align interests with the employer, empower employees to take control of their health, and reduce claim spend. Everyone wins.

Preventive Health Management (PHM) Claims

Preventive Health Management claims are covered at 100% and include the cost of health screenings, blood and claims analysis and reporting, health coaching, and Functional Medicine protocols and oversight. These services are billed to the aggregate as claims, and are eligible under the Stop-Loss policy. ClaimCare will send these claims as an 837 file to the TPA or clearinghouse of choice, if applicable.

Implementation

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Simple. Seamless. Powerful.

IncentiCare is a powerful, affordable health insurance solution. The best part? We've made it easy to administer. Our implementation specialists will guide you through the process and ensure that our product is not only easy for the TPA to administer, but seamless to the client and employees.

BeniComp's implementation specialists create an intimate relationship with TPAs, and guide you through the process to ensure that IncentiCare is easy to administer, and seamless to the employer groups and their employees. With proper implementation, our employer groups, participants, and TPAs experience a seamless integration between the primary plan and IncentiCare.

Our in-depth implementation process includes:

  • A consistent schedule of implementation calls with a dedicated account manager
  • Establish file formats, preferred transfer protocols, and timing. BeniComp has the capability to tailor our system to your specifications.
  • Determine plan designs and build using our intuiitive Plan Building Guide. With proper plan building, claims are processed and paid with little to no manual intervention.
  • Review the projected screening period and when to expect the thorough reward extract that includes everything you need to build the custom IncentiCare Plans.
  • Education and training on Preventive Health Management Claims and how they are processed through the aggregate as an approved claim to be paid at 100%. It is in this step that we connect with any applicable Clearinghouse guarantee that these claims roll through your system as every other claim does.
  • Confirm the invoicing and reporting workflow. So you get paid for implementing an awesome solution to your clients needs!

 incenticare vs all the others


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Kieran Pittman
BeniComp Insurance Company
Director of Strategic Growth
(260) 469-2921
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Jaime Gallo
BeniComp Insurance Company
Director of Operations
(260) 469-2922
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Policies are issued by Pan-American Life Insurance Company.  Not available in all states. 

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