Two benefit designs can be implemented in a group as long as there is a minimum of two contracts in either.
Most businesses with appropriate business licensure and possessing bona-fide employer-employee relationships will qualify.
A minimum of 75% of eligible employees must enroll. See SafeGuard Program Guide for valid waiver specifications.
The monthly payment will change along with changes to the group census.
At any time during the contract period, if a claim exceeds available funds in the pre-funded claims account, an aggregate advance will be made to cover the claim. At the time of settlement, aggregate advances arereconciled against pre-funded claims account monies. Claims which exceed the total annual balance of the pre-funded claims account will be covered by excess loss insurance payments.
At the time of settlement, a determination is made on potential claims outstanding, and USHL Underwriting assigns an incurred but not reported (IBNR) claims estimate. The IBNR claims estimate is retained by USHL to cover any outstanding claims after settlement, and is subtracted from any return of funds due to the employer.
No; excess loss insurance premiums and administration fees are plan fixed costs and are not refundable.
No; USHL maintains and administers the pre-funded claims amount for each SafeGuard client.
Your monthly billing statement will show the breakdown of the portion of your payment allotted to the pre-funded claims account; reporting at month ten will show funds accumulated, claims covered by pre-fund claims account dollars, and remaining balance. Settlement will give final accounting of the funds prior to any distributions.
The employer must continue paying the pre-funded claims account portion of monthly billing through the plan’s year end in order to keep excess loss insurance coverage in place from the plan start date through the date of termination. This account will be maintained until the end of the originally determined settlement period in order to pay claims; the normal settlement process will occur at the originally-scheduled date and any unused funds returned to the employer.
No; the normal settlement process will occur even with re-contracting groups. Each plan year constitutes an entirely new contract, with no “rollover” from a prior year contract period.
SafeGuard allows the employer to select benefit design(s) only; the MPD / SPD, administrative service agreement and excess loss insurance certificate are standard.
USHL handles and decides on all claims disputes.
Self-funded coverage is subject to certain taxes and fees, including the PCORI Fee and Transitional Reinsurance Fee. USHL Client Services assist in calculations of those fees, but payment is the responsibility of the employer.
The monthly administration fees are inclusive of, but not limited to, enrollment, claims processing and adjudication, member cards and plan documents, access to all USHL client service resources (i.e. over the phone and via the fax recall and online secured services portals), coordination with networks and PBMs, claims dispute resolution, member and group communications, excess loss insurance claims coordination and payment, and plan reporting.
SafeGuard requires no more administrative involvement from the employer (plan sponsor) than would be associated with an insured group medical plan.
If I elect to have a HSA, do I have to go through USHL, or can I use my preferred bank? While SafeGuard HDHPs are qualified plans, they may be implemented with or without a health saving account. If the employer group has a preferred HSA bank, we will work with that institution; otherwise, they can use our preferred HSA vendor.
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