Frequently Asked Questions

1. What are the benefits of a self-funded plan?

Self-insured healthcare programs are often preferred over fully insured programs because this option offers greater flexibility in benefit plan design and greater customization in healthcare plan design, as well as favorable strategies for stop loss insurance. It allows employers to see the true costs of their healthcare plan administration. In addition, cost savings resulting from favorable claims experience stay in plan reserves. The premiums of fully insured programs are an unrecoverable expense.

2. What are the characteristics of an employer who chooses self-insurance programs for their employees?

For employers that want to reduce healthcare spending by developing customized plans with integrated wellness and disease management programs, self-funding is an excellent solution. By understanding the drivers of cost increases, companies can explore and implement options to their healthcare programs that will result in reducing the trend of rising healthcare premiums.

3. What products and services are available?

Our healthcare divisions include the following and we invite you to explore the services and options available in each area.

  • HealthSmart Benefits Solutions, Inc.
  • The HealthSmart Preferred Provider Networks
  • HealthSmart Care Management Solutions LP
  • HealthSmart Rx, Inc.
  • HealthSmart Primary Care Clinics LP
  • HealthSmart Information Systems, Inc.

4. What are your most popular programs?

Our Insight solution is one of our most popular and successful programs. It makes a positive impact on your bottom line by integrating the essentials of healthcare: wellness, care management, benefit administration, network access, pharmacy benefit management and risk management solutions.

5. How would a self-funded plan be impacted by healthcare reform?

Although self-funded benefits will be subject to many of the same coverage requirements imposed on insured plans, the cost of self-funded benefit plans will continue to remain lower than that of insured plans. This is because self-funded plans are not subject to state benefit mandates or premium taxes that add to plan costs.

6. Are there any industries that simply cannot take advantage of self-insured programs?

No. Self-insured plans are suitable for all industries.

7. What is stop loss coverage and how does it work?

HealthSmart works with multiple reinsurance carriers to obtain the most competitive stop loss coverage for you. Stop loss insurance is designed to protect employers with self-funded health plans from catastrophic losses when their group medical costs are higher than anticipated due to employee or dependent illness or accident. We use our experience with national carriers to build the most advantageous contract possible. In addition, we audit, file and track all stop loss claims for you.

8. How can I become a participant in your company’s provider networks?

Our provider networks are offered as a standalone option or as part of one of our customized, integrated solutions.

9. How can I get a quote from your company?

We would be happy to put you in touch with one of our sales representatives at 214.574.3546 or by email at sales@healthsmart.com. You can also use our online form to get a quote.