Health Plan Overview

Healthcare is complicated. Traditionally, employers navigate the complexities of health insurance by taking whatever a few big players offer—usually a “one-size-fits-most” proposition, where choice is standardized and the financial gains that result from a healthy, happy workforce reward only the insurance company.

We don’t buy it, and neither should you. In fact, with us by your side, you can design, implement, and manage your own health insurance plans. Our flexibility gets you the plan you want, and our tools and administrative support give you the control you need.

We’ve already addressed the complexities of building networks that offer lower-cost, higher-performance healthcare, and we’ve integrated them into health plan options that are worth your time to investigate.

The combination of our independent-provider networks and strategically aligned benefit plans offers employers and their employees choice, affordability, improved health outcomes, and lower total cost of care.

  • Our Healthcare Highways Health Plan delivers savings by:
    • Steering members to appropriate in-network providers through our care coordination, benefit designs and member engagement.
    • Committing to claim integrity including our robust claims monitoring protocols where we check billing appropriateness before claims are processed and paid timely and accurately.
    • Providing extensive medical management of large cases or chronic diseases that leads to more cost savings.


Administration

Employers that self-insure its medical plan for their employees often seek outsourced partners who can bear much of the administrative burden, and it is here that expertise and well-equipped resources and facilities can contribute to lowering healthcare costs. Healthcare Highways Health Plan offers the people, platforms, and expertise that are necessary to handle claims through the entire adjustment, auditing, and appeals process and to administer services like underwriting, stop loss, and premium billing.

Our dedicated account executives become your single point of contact for direct implementation, member enrollment, and renewal, backed by our customer service call center and online self-service portal for members.

Employers, too, have a secure portal to support convenient uploads of information as plans are implemented and changes in the workforce occur. Employers also have access to information about benefits and claims and how their healthcare plan is performing, among other features.


Stop Loss Services

Medical stop loss provides protection against catastrophic or unpredictable large claims. Stop loss services are appropriate for employers who have decided to self-fund their employee benefit health plans but do not want to assume 100% of the liability for losses that arise from their health plans.

Healthcare Highways Health Plan is rated by an A.M. Best A+ Superior stop loss company. Healthcare Highways Health Plan participates in the risk through arrangements with partners, so our partners are as important to us as they are to our clients.

  • Stop Loss services

    Employers who are interested in stop loss services first receive a stop loss proposal. The service includes:
    • Collection and posting of health plan premiums
    • Statistical recording and reporting of claims and health plan premiums
    • Claim audits
    • Daily printing of reimbursement checks
    • Collaborative calls to set strategies for each case


Precertification and
Utilization Review

By identifying high-risk cases through precertification, we can begin to manage our high-risk members early on, which increases the opportunity for cost savings.

By providing much more than the criteria for authorization, our evidence-based clinical guidelines drive high-quality care through tools like care-pathway tables, flagged quality measures, and integrated medical evidence. Automated triggers in our system identify members who may benefit from case management intervention, which supports the quality of care and cost containment.
Our utilization-management services include precertification, concurrent review, and discharge planning. Precertification requirements can be customized based on your requirements and your plan.