Health Plan Basics

Why HLU?In business since 1961, we are fully independent consultants with each employer’s best interests in mind. We have 55 years of experience in the industry, backed by a team of professionals who truly understand what works in a plan and what doesn’t. We are a focused and efficient company with national reach that takes an objective approach to finding the best vendors.

Our Method• You’ll work in partnership with the

same account representative who is focused on the full relationship, from sales to implementation and strategy

• You’ll receive one-on-one customer service with a high-touch, hands-on approach

• You’ll never have to worry aboutbrand-name fees, incentives or sales driven by commission coming into play

Tad KrafftHealth Plan Consultant

513.559.7504 directtadkrafft@hluconsultants.comhluconsultants.com

Claims 70%

Admin. 10%Insurance

20%

HLU CONSULTANTS | Reclaim Control of Your Health Plan

Employee HealthPlan ID Card

Health CareRecieved

Health CareProvider is Paid

EOB

Employee ReceivesExplanation of Benefits

Claim isProcessed

NationalBenefit

Administratorwith Advanced Claim

Processing andOne-on-One

Customer Service

Insurance CompanyClosed Platform

Claim ProcessNo transparency,

control or analysis

HLU Open-PlatformClaim Process

OptionsTransparency

ControlAnalysis

Stop-LossInsurance

to Protect AgainstLarge Claims and

Provide Guarantees

The Employee Routine is Unchanged

What Happens During the Claims ProcessInvisible to Employee

Large ClaimReview

Itemized ClaimReview vs.

Summary or RBPHR Services,

ACA Complianceand Payroll

The Nerve Center:Controlled by the

Summary Plan Description(SPD)

DiseaseManagementand Wellness

THE CLAIMS PROCESSTypical Health Plan Costs Breakdown

THE 4 FUNDAMENTALS:Why HLU Open-Platform Health Plan is the Unbeatable Solution

Here’s the thing –Most companies have no idea how much their health claims are costing them or that the issue of excess, unnecessary charges has become so incredibly routine.

All too often, claims get processed and paid without a thorough review to catch errors and inconsistencies.

Common issues like overcharging, miscoding and duplicate charges are slipping through the cracks and resulting in ridiculously high payments that are eating away at your bottom line. The costs – and savings – add up!

Company A

• Distribution company with 175 employees would have spent $1,183,000 in claims.

• 46% of the claims were driven by large claims in excess of $15,000 and were incurred by just 3% of the employee population.

• Our intelligent claim review process uncovered $168,000 in overcharges and miscoded claims.

• These savings were over and above thePPO discounts.

Company B

• Manufacturing company with 140 employees would have spent $124,000 in pharmacy costs.

• Our intelligent claim review process uncovered $13,600 of excessive Ingredient Cost Paid (ICP).

• Same drugs, same pharmacy, 11% savings.

Control of Health Plan Employer Insurance company Insurance company

Provider Network Access

Data Analysis & Forecasting

Large Claim Case Management Analysis

Utilize Independent, Best-In-ClassVendors to Reduce Claim Costs

Pricing Transparency forEmployee Medical Services

Customizable SummaryPlan Description (SPD)

Claim Review Procedure

Compliance & Employee Onboarding

HLU Open-Platform Health Planwith Healthcare Intelligence

Hybrid Plan PlatformASO, Insurance Company, Self-Funded,Level-Funded, Balance Funded Plans

Closed PlatformHumana, Anthem, UHC, MMOH,

Aetna, etc.

Traditional PPO Networks, National Accessand Customizable Networks

Typically 1 or 2 PPO options(One size fits all)

Typically 1 or 2 PPO options(One size fits all)

YES - actionable data Basic claims and expense overview onlyData is not actionable

No data provided

YES - actionable data No No

YES No No

YES No or limited No or limited

No or limited

YES Yes - with limitations No

Claims are itemized and reviewed forovercharges and billing errors

Full Service, Hands-Free Suite: FMLA, COBRA,5500, ERISA, ACA, FTE Record-Keeper and filings

Claims are passed through and paidby a summarized invoice

LimitedUsually reference materials only

Claims are passed through and paidby a summarized invoice

Claim Costs Quiz

1. Do you know how much money you pay for claims each year?

YES NO

2. Do you have a way to control your claim costs?

YES NO

3. How often do you review and update your SPD?

4. Do you review your Pharmacy ICP (Ingredient Cost Paid) and DAW (Dispensed as Written) Claims?

YES NO

5. Are large claims (>$15K) billed by Uniform or Itemized bills?

UNIFORM ITEMIZED

6. What percent of your overall claim spend is driven by claims >$15K?

HLU CONSULTANTS | Reclaim Control of Your Health Plan hluconsultants.com | 513.559.7504 | tadkrafft@hluconsultants.com

But things can change.Of all the health plan options out there, what makes self-funding with HLU Consultants and our open-platform the sure thing? It starts with a customized, employer-controlled Summary Plan Description (SPD) . . . the blueprint and nerve-center that puts you in control of your plan and its dollars.

A customized SPD based on an open-platform model provides the opportunity for pricing transparency, which empowers you to create a competitive pricing environment. Combining the SPD and our best-in-class customer service, your plan is powered by four key fundamentals – all “difference-makers” in terms of plan success for the long-term.

Who controls your SPD?

LowerClaim Costs

EmpoweredEmployees

ImprovedQuality of Care &Better Outcomes

AN AVERAGE OF

27%

To Reduce Over-Utilizationand Improve Care

HLU Open-Platform Health PlanPuts Control and Cost Savings Back in Your Hands

HLU’s Winning Formula

1. Intelligent Claim Review 2. Disease Management Education

3. Fair Pricing Education 4. Plan Modeling

The Strategy

Unmanaged claim costs are often the reason behind skyrocketing plan expenses. Consider these numbers: an average of 27% reduction in health claim costs per employer and more than $225 million saved altogether. How are they achieved? HLU works with specialized vendors to provide advanced, intelligent claim technology.

Here’s how it works:• Instead of a pay-and-go approach, claims

are pored over line-by-line to prevent errors and overcharges from slipping through the cracks

• Employers pay actual claim costs, not inflated costs bloated with insurance company profit and overhead. This reduces the large profit margin currently paid to your health plan company

• An ongoing review of meaningful and actionable claims data is done to help enhance value, and ultimately, improve health care outcomes

The End Result

With HLU, you receive the most efficient and advanced claims processing. Our thorough review process generates savings over and above the negotiated PPO rates and has a significant impact in driving down health plan costs. Plus, there’s no need to worry about large, unexpected expenses because your health plan is protected by stop-loss insurance to provide a guaranteed cap.

You don’t have to worry about a change in routine for your employees. Our technology

and review process runs quietly in the background. Your employees continue to provide an ID card at time of service and receive an Explanation of Benefits (EOB) just like they always have. The one change they will notice is fairly priced health care.

The Strategy

Constantly growing more complex, the health care system is tricky for employees to navigate. So why not give them better tools to find their way? HLU offers a service that features a coordinated care system to simplify disease management. It gives employees a single contact with access to a team of nurses, patient service representatives and more. Dialing into this resource, employees can ask questions about what kind of testsand/or procedures are necessary and get pointed in the right direction to receive proper care.

The Strategy

Due to the lack of pricing transparency among health care services today, employees are paying too much and receiving sub-par services in return. This doesn’t have to be the case. HLU offers a solution that shows employees where to find the most cost-effective services within their provider networks. This service addresses quality, too, and goes beyond the overall rank for facilities. It drills down by procedure type and reveals which providers or facilities offer the best of the best according to clinical category.

The Strategy

As claim data and behavior are collected, HLU Consultants is able to do some serious number crunching using our plan modeling process. We can look at historical data for all coverage areas and compare the actual plan cost to the model plan cost. This includes member deductible,co-pay and coinsurance – three areas where we are able to achieve some pretty significant value in a self-funded plan.

The 4 Fundamentals of the HLU Open-Platform Health Plan

HLU CONSULTANTS | Reclaim Control of Your Health Plan

The End Result

Education is everything. This proactive approach to disease management makes employees savvy consumers and leads to informed decisions about care, smarter spending and better outcomes.

Check out these stats from a 2014 study:• Financial savings – 20% lower cost by the

third year

• Usage efficiency – 15% increase in both primary physician and preventive care use; 18% reduction in re-admission rates

• More engagement – 84% of households engaged in conversation with a care coordination team member as did 48% of members with a chronic condition

• Increased satisfaction – 94% satisfaction rate among plan participants surveyed

The End Result

How much can you save when your employees are more knowledgeable about pricing and quality transparency? Up to 12% off plan costs. We’re talking savings on everything from a routine MRI and ultrasound to specialized cardiac and cancer care.

Over time, as we learn the behavior of your employees, we’ll help you design

creative and easy ways to engage your employees in finding the highest quality, most affordable care without creating hassles or restricting access to care.

The End Result

Whether studying the numbers supplied or seeing the savings in visual form on a pie chart, plan modeling is often eye-opening to employers. It shows exactly where you can increase value to the employees without impacting your bottom line. Or, if you need to reduce plan costs, our plan modeling analysis will model the overall and individual member impact so you can make an informed decision.

hluconsultants.com | 513.559.7504 | tadkrafft@hluconsultants.com

Reclaim Control of Your Health Plan

HLU CONSULTANTS | Reclaim Control of Your Health Plan hluconsultants.com | 513.559.7504 | tadkrafft@hluconsultants.com

Notes & Goals: