Frequently Asked Questions
Q: Because this program is technically a ‘Self- Funded’ Program, does that mean our group has to
have reserves set aside to cover the claims in case of a bad month (or year)?
A: NO. Because of the insurance components of the program, we have taken the best aspects of a
self- funded program and the best aspects of a fully-insured program and blended them together.
This is a fixed-cost, level-funded program. Your rates are your rates, period.
Q: What does Level Funded mean?
A: The Lifestyle Health Program is ‘level funded’ meaning that by design, any risk to the
sponsoring employer
has been removed beyond the 12 months of premium paid. Based on employer size, we can offer a
unique, self-funded health benefit program that maximizes the benefits to employees, while
implementing cost-saving opportunities for employers to stabilize benefit costs without reducing
benefits.
Q: If our claims exceed the allotted amount, what happens? Do we have to come up with the
difference at the end of the year?
A: NO. The Lifestyle Health Program is level funded by your monthly premiums. Regardless of what
your claims experience is in any given plan year, you will never pay more than the monthly cost
quoted to you
Q: If we choose to leave the program at the end of the plan year, is there a termination cost
associated with the plan?
A: NO. All run out costs are accounted for within the monthly premiums.
Q: During our plan year, what if our claims run better than expected?
A: Once all claims have been paid for the plan year, any unused dollars in the claims fund will be
used to reduce future premium rate increases. In the event of a plan termination, each employer is
eligible to receive back
any unused dollars in the claims fund after the run out period.
Q: Will our employees and administrators have to do more work on this type of program?
A: NO. By partnering with Medova Healthcare, the program’s Third-Party Administrator (TPA),
administrative burdens are removed from both the employee and the employer. Employees play their
usual role including seeing providers within their PPO Network, using their
ID card at the provider’s office, paying a copay and then paying their shared responsibility. The
employer simply pays their monthly premiums. Medova then handles the rest! No claims filing, no
separate accounting, no extra work!
Q: Are there any startup costs to our Lifestyle
Health Plan?
A: The only start-up cost is your first monthly premium payment.
Q: Will my employees still have access to their hospitals, doctors and pharmacists?
A: By choosing from multiple national and regionally based PPO networks, we try to match up the
providers
as well as possible. As with any change in carriers, some providers aren’t in every network. We
thoroughly examine the networks that are available during the decision- making process.
Q: What about the benefits? Will they be ‘apples to apples’ to our current plan?
A: The Lifestyle Health Program offers 16 different plan designs that your group may select from.
Depending
on the group size, up to 4 plans can be offered to the employees to choose from. While there will
be some differences between the LHP plans and your current plan, we should be able to improve the
benefits to the employees by offering a deductible credit through the Wellness Program as well as
some other value-added benefits (Care Coordination, Lab Benefit, Diabetic Supplies, Telemedicine,
Rx Benefits, etc.).
Q: What are some of the cost-containment features with our Lifestyle Health Plan?
A: A key focus for Lifestyle Health Plans is finding creative ways to manage healthcare costs.
Traditional benefit designs and cost management techniques have been relatively unsuccessful in
assisting employers and their members with cost containment. Lifestyle Health has integrated a
number of cost management programs and benefit coverage solutions into our plan designs. Some of
these address ER utilization, implant cost containment, specialty medications and self-injectables
and alternative generic drug utilization.
Q: What options are available to ensure that my group is ACA-compliant?
A: For groups of over 50 eligible lives, Lifestyle Health Plans offers a turnkey solution for group
medical benefits, including five Minimum Essential Coverage (MEC) Plans and a variety of plans that
meet Minimum Value. In addition, from the standard 16
plan designs, there are also a host of ‘buy up’ options for richer benefits. The whole program
offers turnkey administration and billing through Medova Healthcare.
Q: I have never heard of Lifestyle Health Plans.
Will my doctor recognize it? Is this a new program? How do we know that it won’t fail? I know my
current carrier and they are huge.
A: Lifestyle Health Plans is an innovative, boutique health benefits program and has been offered
throughout the country since 2006 in partnership with a host of A-rated reinsurance carrier
partners. Since Lifestyle relies on PPO networks for discounts and re-pricing, it is important
to use a doctor in the network selected ( just like your current plan). On your Member ID Card, you
will find
a logo for your plan’s PPO Network. Your provider will recognize the PPO Network even if they have
not yet had extensive experience with Lifestyle.
Q: What are the benefits of having a Third-Party Administrator (TPA) handle our claims versus
having a carrier do it?
A: Many would say that traditional carriers are first concerned with their bottom line, not yours.
A Third- Party Administrator (TPA) works solely on your behalf and has your group’s interests in
mind. As the program administrator, Medova Healthcare strategically partners with each client
company to proactively address factors that contribute to the rising cost of healthcare. Plus,
wouldn’t it be nice to speak directly to the person who pays your claims versus a different
customer service
person every time you call? At Lifestyle Health Plans, our committed member and client service
teams are here to support our agents, clients, and employee members. A friendly voice and great
customer service… all standards of care for you, our client.
have reserves set aside to cover the claims in case of a bad month (or year)?
A: NO. Because of the insurance components of the program, we have taken the best aspects of a
self- funded program and the best aspects of a fully-insured program and blended them together.
This is a fixed-cost, level-funded program. Your rates are your rates, period.
Q: What does Level Funded mean?
A: The Lifestyle Health Program is ‘level funded’ meaning that by design, any risk to the
sponsoring employer
has been removed beyond the 12 months of premium paid. Based on employer size, we can offer a
unique, self-funded health benefit program that maximizes the benefits to employees, while
implementing cost-saving opportunities for employers to stabilize benefit costs without reducing
benefits.
Q: If our claims exceed the allotted amount, what happens? Do we have to come up with the
difference at the end of the year?
A: NO. The Lifestyle Health Program is level funded by your monthly premiums. Regardless of what
your claims experience is in any given plan year, you will never pay more than the monthly cost
quoted to you
Q: If we choose to leave the program at the end of the plan year, is there a termination cost
associated with the plan?
A: NO. All run out costs are accounted for within the monthly premiums.
Q: During our plan year, what if our claims run better than expected?
A: Once all claims have been paid for the plan year, any unused dollars in the claims fund will be
used to reduce future premium rate increases. In the event of a plan termination, each employer is
eligible to receive back
any unused dollars in the claims fund after the run out period.
Q: Will our employees and administrators have to do more work on this type of program?
A: NO. By partnering with Medova Healthcare, the program’s Third-Party Administrator (TPA),
administrative burdens are removed from both the employee and the employer. Employees play their
usual role including seeing providers within their PPO Network, using their
ID card at the provider’s office, paying a copay and then paying their shared responsibility. The
employer simply pays their monthly premiums. Medova then handles the rest! No claims filing, no
separate accounting, no extra work!
Q: Are there any startup costs to our Lifestyle
Health Plan?
A: The only start-up cost is your first monthly premium payment.
Q: Will my employees still have access to their hospitals, doctors and pharmacists?
A: By choosing from multiple national and regionally based PPO networks, we try to match up the
providers
as well as possible. As with any change in carriers, some providers aren’t in every network. We
thoroughly examine the networks that are available during the decision- making process.
Q: What about the benefits? Will they be ‘apples to apples’ to our current plan?
A: The Lifestyle Health Program offers 16 different plan designs that your group may select from.
Depending
on the group size, up to 4 plans can be offered to the employees to choose from. While there will
be some differences between the LHP plans and your current plan, we should be able to improve the
benefits to the employees by offering a deductible credit through the Wellness Program as well as
some other value-added benefits (Care Coordination, Lab Benefit, Diabetic Supplies, Telemedicine,
Rx Benefits, etc.).
Q: What are some of the cost-containment features with our Lifestyle Health Plan?
A: A key focus for Lifestyle Health Plans is finding creative ways to manage healthcare costs.
Traditional benefit designs and cost management techniques have been relatively unsuccessful in
assisting employers and their members with cost containment. Lifestyle Health has integrated a
number of cost management programs and benefit coverage solutions into our plan designs. Some of
these address ER utilization, implant cost containment, specialty medications and self-injectables
and alternative generic drug utilization.
Q: What options are available to ensure that my group is ACA-compliant?
A: For groups of over 50 eligible lives, Lifestyle Health Plans offers a turnkey solution for group
medical benefits, including five Minimum Essential Coverage (MEC) Plans and a variety of plans that
meet Minimum Value. In addition, from the standard 16
plan designs, there are also a host of ‘buy up’ options for richer benefits. The whole program
offers turnkey administration and billing through Medova Healthcare.
Q: I have never heard of Lifestyle Health Plans.
Will my doctor recognize it? Is this a new program? How do we know that it won’t fail? I know my
current carrier and they are huge.
A: Lifestyle Health Plans is an innovative, boutique health benefits program and has been offered
throughout the country since 2006 in partnership with a host of A-rated reinsurance carrier
partners. Since Lifestyle relies on PPO networks for discounts and re-pricing, it is important
to use a doctor in the network selected ( just like your current plan). On your Member ID Card, you
will find
a logo for your plan’s PPO Network. Your provider will recognize the PPO Network even if they have
not yet had extensive experience with Lifestyle.
Q: What are the benefits of having a Third-Party Administrator (TPA) handle our claims versus
having a carrier do it?
A: Many would say that traditional carriers are first concerned with their bottom line, not yours.
A Third- Party Administrator (TPA) works solely on your behalf and has your group’s interests in
mind. As the program administrator, Medova Healthcare strategically partners with each client
company to proactively address factors that contribute to the rising cost of healthcare. Plus,
wouldn’t it be nice to speak directly to the person who pays your claims versus a different
customer service
person every time you call? At Lifestyle Health Plans, our committed member and client service
teams are here to support our agents, clients, and employee members. A friendly voice and great
customer service… all standards of care for you, our client.