Self-Funded Health Plans Backed by the Benefits of Blue
We offer a comprehensive, yet tailored, client-first approach to self-funded health plans, whether your business is local or national. We’ll help you understand compliance requirements — specific to your business — so you can build a package that helps protect your company and plan members as well as optimizes your investment.
Self-funding gives you access to your claims data to help determine what’s driving your health care costs. And because you have more control over plan design, targeted changes can be made to help control those costs. Its flexibility also lets you embrace new health care delivery models and plan design innovations that make sense for you. Let us help you build a targeted self-funded plan designed to help improve health and lower costs.
Looking to learn more about how Independence Administrators can help turn the new health care landscape into your competitive advantage? Or have a question about your existing account? We can help.Contact Us
Our Approach to Self-funding*
Our strategy for self-funded health plans leverages the power of the Blue networks and value-based initiatives to target three key aspects of health care — Health Management, Plan Management, and Cost Management.
Effectively balancing and optimizing these components helps enhance the experience of accessing care while working to improve health and lower costs. It’s a plan sponsor’s version of the Triple Aim.*Independence Administrators does not provide legal or tax advice. Please consult with your legal/tax advisor regarding your legal and tax obligations with respect to a self-funded plan.
Independence Administrators can help plan members get healthy, stay healthy, and manage chronic conditions. Our clinical services team of registered nurses and trained health coaches uses claims analysis, biometric data, and personal health profiles to help develop interventions that best suit your population.
We combine insight and compassion to help care for both the population and the individual. Our medical management programs help achieve high-quality and cost-effective care while helping to maximize the plan member’s overall health.
Our suite of program options allows you to customize a wellness program based on the needs of your population. The goal is to reduce costs and improve overall health.
AmeriHealth Administrators, our medical management company, has received Case Management Accreditation from NCQA for its complex case management program. The standards are intended to help organizations achieve the highest level of performance possible; increase adherence to care guidelines; and create an environment of continuous improvement.
We identify members with chronic or complex conditions and provide them with education, support, and health coaching to help improve their outcomes — and help you better manage health care costs.
Health utilization management
AmeriHealth Administrators, our medical management company, was certified by NCQA in Utilization Management.1 Achieving Utilization Management certification from NCQA demonstrates that AmeriHealth Administrators has the systems, process, and personnel in place to conduct utilization management in accordance with the strictest quality standards.
Enjoy convenient, 24/7 access to non-emergency care at lower costs than visits to an emergency room or urgent care center. This virtual care delivery model enables secure consultations with a board-certified physician over a telephone, computer, tablet, or mobile app. It can help decrease absenteeism and speed recovery by providing plan members fast, convenient access to care for routine illnesses.2
Blue Distinction® Specialty Care
To help reduce complications, lower readmission rates, and, ultimately, lower costs, the Blues have created the Blue Distinction Specialty Care program. This special designation recognizes facilities that demonstrate expertise in delivering safe, effective, and cost-efficient specialty care procedures for cardiac conditions, knee and hip replacement, spine surgery, transplants, bariatric surgery, and maternity care.1 NCQA has reviewed and certified AmeriHealth Administrators Utilization Management functions only. For complete details on the scope of this review, visit www.ncqa.org.
2 MDLIVE, an independent company, provides telemedicine services to Independence Administrators. Telemedicine services from MDLIVE are for nonemergency conditions only, subject to state regulations, and may not be available in certain states.
Blue Distinction is a registered trademark of the Blue Cross and Blue Shield Association.
Our approach to health plan management emphasizes customer engagement. Through consultation, detailed reporting, and administration support, we help plan sponsors and their plan members navigate the complexities of accessing health care to help improve the overall experience.
We understand each client is unique. We listen to you, then tailor programs to support your specific objectives. Our team measures the program’s success and can recommend potential changes to help improve your plan’s performance.
Our dedicated implementation team helps make the onboarding process easy. We walk you through the details, including eligibility, enrollment, and claims.
Using our intelligent reporting suite, we can help you evaluate and implement plan design changes and other strategies to help control costs and improve health.
From electronic data interchange services to client support teams, we provide you with resources to help better manage your self-funded health plan — both online and off.
Helping keep your population informed is an important part of managing health. That’s why we provide 24/7 access to plan details and a wide-range of resources designed to help them do everything from finding a preferred doctor to living a healthier lifestyle.
We combine our clinical resources and customer engagement model to help design a plan that fits your population and business objectives. We then help you reduce costs by providing value through unique plan designs, network discounts, incentive programs, and risk management.
Our comprehensive plan designs are tailored to meet your specific needs, and are backed by the combined power of our experts and state-of-the-art technology.
Largest provider networks
With access to the Blue networks, you and your plan members have access to doctors and hospitals across the street; across the country; and in more than 200 countries and territories around the world — all at competitive rates.
High-performance, custom networks are available in select geographic areas to provide high-quality health care at additional savings1.
Our fraud prevention safeguards help to identify duplicate claims, up-coding, and unbundling as well as incompatible procedures and diagnosis codes. These processes — coupled with a team of experienced claims examiners — help assure you get the best value for your health care spend.
Stop Loss coverage helps protect you against high-dollar claims, helping you manage risk. We also offer a preferred Stop Loss arrangement that integrates with your self-funded health plan.
1 Some restrictions and limitations apply.
Transparency in Coverage Rule (TCR) and the Consolidated Appropriations Act (CAA)
In response to the Federal TCR and CAA, Independence Administrators has established an enterprise-wide implementation program to ensure all requirements are implemented by the mandated compliance dates. The requirements for implementing the TCR and CAA are evolving, and Independence Administrators is committed to meeting the requirements by the mandated compliance dates.