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Partners Benefit Group, Inc.
Participating Funding Arrangements
105(h) Administration
A Participating Funding Arrangement (aka
PFA or 105(h) Employee Reimbursement Plan) is a program set
up to for an employer to reimburse its employees for the uninsured
medical expenses that are not covered by the employer health
plan. Reimbursable expenses may include copays for office
visits, emergency room visits, inpatient admissions, outpatient
surgeries or imaging tests, as well as all or part of the
plan deductibles.
Reimbursement payments to the employee are
deductible for the employer on the same basis as insurance
premiums paid to an insurance company. Plan installation and
administration is simplified by Partners Benefit Group. Information
is obtained via the health plan enrollment form and online
carrier access.
Partners Benefit Group works with employers
to customize the plan design. Based upon claims experience
from PBG clients and information received from Massachusetts
carriers, a projected claim cost is established. This information
is used to determine "Billed Rates."
The PBG Participating Funding Arrangement
allows employers to reduce costs and still maintain a benefit
plan with lower copays and deductibles. Partners Benefit Group
handles the administration which streamlines the process and
protects the privacy of the member.
The advantages for employers include:
Reduces overall cost of health plan.
By purchasing a plan with high copays or deductibles, the
premiums are significantly less. A portion of the savings
is used to reimburse employees for claims. Frequently, the
reimbursement amounts are much lower than the premium savings
which results in significant savings.
Plan Design Flexibility. The employer
may determine which benefits are reimbursable. Often the plan
design is similar to that of a traditional (Non-High Deductible)
HMO plan.
Conserve Capital. The employer does
not have to make an investment in systems and software. The
PBG proprietary software tracks eligibility, claims, and reimbursements.
Compliance. Employer removes the
possibility of HIPAA and/or ERISA violations by placing a
third party between an employee's confidential medical records
and the HR Department.
Streamlined Claim Reimbursement.
PBG has a staff of experienced claims personnel. Reimbursements
are processed quickly and accurately.
Access to Claims Data in Massachusetts.
Health insurance carriers do not provide claims experience
to employers with less than 100 enrolled employees. PBG provides
reimbursable claims data and then assists employers with future
plan designs and cost projections.
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