$200,000 unused claim dollars returned to Employer.
About the Client
A Midwest-based retail Employer with 180 employees who had previously received a 25% fully-insured increase from a regional HMO.
Pain Points & Priorities
Due to recent ACA regulations, the new community-based rating caused a much larger and unexpected increase in the Employer’s healthcare plan. Other fully-insured carrier options were uncompetitive and the Employer did not see a solution. The net increase was equal to $180,000.
Lucent Vista’s level-funded approach was able to deliver a self-funded solution that matched the fully-insured benefits but also delivered rates that were equivalent to the pre-renewal rates.
In addition to the first self-funded savings, the Employer also had an exceptional claim year and received $200,000 in unused claim dollars. This positive claim experience for the Employer also drove a second year’s rate reduction as well.
Finally, the member was engaged at the very beginning of their medical journey and needed highly personalized support.
Impact & Results
Employer tracking of medical trend and plan financial performance was enhanced with Lucent Vista’s proprietary reporting and in-person reviews; this helped to drive:
- $200,000 unused claim dollars returned to Employer
- A second year of rate reductions and helped reduce trend
- Employer now enabled to aggressively leverage customized plan performance data