National Provider Network
With Level Funding, Simple Funding uses a national network of hospitals and doctors with access to providers and their corresponding discounts. To manage the healthcare of your employees and their families properly, with preventative care and wellness programs, providers need the benefit of long-term patient relationships. Our national network partner offers this as the depth of healthcare services needed to meet that goal.
Third Party Administration (TPA)
Central to the function of any health plan is administration. With the Level Funded plan, billing, premium collection, banking arrangements, claim payment, member services, printed literature, benefit utilization reporting and most general plan management services flow through the TPA. Using advanced technology in combination with experience and savvy, we provide superior plan administration combined with valuable financial and risk management reporting.
Pharmacy Benefits Manager (PBM)
Our pharmacy program is designed to deliver better performance for clients with programs focused on keeping medical, behavioral and drug benefits directly connected. When monitored and managed together, we can provide clients with more information and insight to help them lower health care costs, gain better outcomes, and provide a more personalized and enjoyable customer experience.
On your behalf, Simple Funding engages all of the components of the plan and delivers them in a packaged format. Ongoing financial, risk and plan management services are also provided. In cases of severe medical events, we will represent the Plan in negotiating with insurers for positive patient outcome. With advancements in medical care, the associated enormous costs and the "unlimited maximum benefit" requirement for coverage, large loss management protocols will become increasingly important to long term Plan management.
Simple Funding's reports identify trends in healthcare spending (a macro view) as well as opportunities for specific member level care improvement/cost avoidance (a micro view). We provide guidance for evaluating health plan performance, benefit planning, areas of cost avoidance, and clinical intervention opportunities.
Simple Funding works with a number of insurers. This allows you to change insurers, should your carrier become unreasonable, without disturbing the valued provider and administrator relationships discussed above. This Plan flexibility is critical to keeping the long-term relationships so necessary to effectively managing the healthcare of your families. Stop loss insurance contracts will include monthly aggregate reimbursements, specific excess advancements and terminal cap protection.