Post on 24-Jun-2020
Know Your ScoreUp-front assessment of group’s
health risk.
Review employee health history to evaluate risk.
Level Funding is for healthy groups of 5-150 employees.
Follow the Money Self-insured plan with a fixed monthly budget
- similar to a fully-insured plan.
Pay one fixed monthly payment that includes: Administration: plan operation and broker
services, Claim Funding: money for members claims, and
Stop Loss: insurance covers high claims beyond the monthly budget.
Change the Game with a Level Funding
Health Plan
Prevent SurprisesIf claims exceed claim fund, stop loss
insurance advances the di�erence.
Once claims are settled for the plan year TCC returns surplus to the employer -
and stop loss covers any deficit.
Most years most groups see a surplus.
Enjoy Your Own Private PoolFully-insured claims are “pooled” with
other groups.
Level-funded groups pay for their own claims,not the “community pool”.
Health management services help members improve their health and slow your health care spend.
Administration of self-funded, level funded,fully-insured, limited benefits, temporaryhealth and supplemental gap plans.
Utilization review and large case management services to optimize care at an appropriate cost.
Monthly reports help you understand how your plan is running and aid in designing the best benefits for your group.
Wellness and population health managementfocus our expertise on the 20% of yourmembers who generate 80% of your claims.
Pharmacy benefit management through cost e�ective PBMs including savings on expensive specialty drugs.
TCC Benefits Administrator is a full service third party administratorlocated in Charleston, South Carolina.Since 1972 TCC has earned a reputation for self-funding expertise, leading edge technology, and legendary customer care. Many of our clients have been utilizing TCC services for decades.
Many of our sta� have been with us for decadesas well. You’ll find our associates knowledgeable, e�cient and charming. Yes, charming. This is Charleston after all. TCC is small enough that you’ll know your contacts by name, yet part of a large, A+ (superior) health insurance group, providing enormous resources.
We put it all together with you and yourbroker. Consider all that TCC canprovide:
Network access for members to choose from for the best medical providers and realize in-network savings.
Out-of-Network savings through secondary, tertiary networks, as well as direct provider fee negotiation.
Delivering Creative Benefit Solutions for Business
ACA 6055 and 6056 employer datareporting requirements services.
Stop loss coverage from our preferred carriers protects your claim fund againsthigher than expected claim payments.
TCC systems are cutting edge from companies such as Trizetto, Hillary Software, RedCard and Deerwalk.
Management team of four with combined130+ years of experience in health benefitsfor groups and individuals.
Maximize the value of your benefits and minimize your costs. Let’s talk today!
Value added options like HRAs, FSAs,ancillary benefits and voluntary employee benefit programs.
Optional cloud-based online portal foremployee self-service, administratorsuite, and customer service call center.
Delivering Creative Benefit Solutions for Business
PU.sotoho
Co USwi TTeafpr Amwa Te
opulation H.S. Preventiv
olution. The Pouch populatiospitalization
overed emplo
SPM is the onith wellness-s
elemedicineladoc is the ffordable healrescriptions a
mericans canait. Then spen
eladoc physic
Board cphysicilicensedstate
LHealth Ma
ve Medicine Preventive Plaion health mas, ER visits an
oyees receive
nly wellness csensitive med
ne Serviceslargest provi
lthcare via phare sent to you
n’t get timely nd half a day a
cians are boar
Str
A
Cus
certified ans d in your
Level Funagement
(USPM) creaan provides inanagement pnd costs. USPM
an annual bio
company to acical events fo
s through Tider of telehe
hone and videour pharmacist
doctor appoinaway from wo
d-certified in
aight forwa
Simplified h
Clean, mob
Sync over
Video and
Access to th
stomized he
Avaphoat aday
unding
ated an infornnovative toorogram that M counsels th
ometric screen
chieve a sustar Asthma, Car
Teladoc
alth medical o consultationt. And the con
ntments. Theork for a 4-min
internal med
rd action it
health log fo
bile-friendly
r 100 wearab
d searchable
he Cleveland
ealth tips an
ailable by one or onliany time oy or night
Progra
rmation technls and servicehas produce
he 20% of your
ning and follo
ained and sigrdiac Events,
consultationsns – whenever
nsultation com
e result? Theynute visit. And
icine, family p
ems and eas
or easy entr
y, and intuit
ble devices/
e health libr
d Clinic eCo
nd motivatio
ine of
am High
nology platfoes that encomd proven, pur employees w
ow up coachin
gnificant reduCOPD, Cong
s in the USA,r they need it
mes with zero
y go to costlyd there is no t
practice, eme
sy incentive
ies
tive look an
/application
rary
oaches
onal messag
Telemediprovided cost to thmember
hlights
orm for a pempass an integublished reduwho generate
ng at zero out-
uction in healtestive Heart F
, providing mt, from wherevout-of-pocket
y ER and urgetime limit to a
rgency medic
e tracking
d feel
ns
ging
icine at no
he
:
ersonalized pgrated high-t
uctions in hea80% of your c
-of-pocket cos
thcare costs aFailure and D
members 24/7 ver they are. Nt cost.
ent care clinica Teladoc cons
cine and pedia
preventive ech, high-alth risks,
claims.
st.
associated iabetes.
access to Necessary
cs, or they sultation.
atrics.
M TCemne TCou
M DiToin Mhim M
Managed Ca
CC brings youmployees andetwork solutio
CC also offersutperforming
Medical Adv
id you know to find a phys
ndependent an
MAP makes evidden data ab
mortality index
MAP seamlessl
Give y
are Progra
u high quality won’t balanc
ons that meet
s non-networkthe industry a
vocate Pro
that costs for sician or spend unbiased in
ery network about providerx, and total co
ly coordinates
your emplo
ms
y local providee bill the patiethe needs of y
k fee negotiataverages for n
Nation
North C
So
ogram for H
the same medecialist, look nformation ab
a high-performrs, such as prst – including
s the pre-auth
oyees and
er networks. Oent for more tyour group, a
ion as a signifnon-network c
nal employee
arolina and V
outh Carolin
High-Quali
dical procedurto the Medic
bout provider
mance networrocedure volug physician, m
horization pro
their fam
Our healthcarthan our negochieving the g
ficant cost-sacharges.
coverage in
Virginia emp
na employee c
ity Cost-Ef
re can vary bycal Advocate s for the best
rk by identifyiume, outcomematerials, and
ocess with the
ilies the b
re professionaotiated amoungreatest savin
aving benefit f
cluding trav
ployee covera
coverage
ffective He
y thousands oProgram. Re
care possible
ing the very be quality, comfacility.
se health care
est health
als file all the nt. Our team wngs, quality an
for our clients
vel
age
ealth Care
of dollars withegistered Nure at the lowest
best providersmplication rat
e navigation s
h care at th
claims for youwill create regnd coverage.
s, consistently
hin a providerrse Advocatet cost availabl
s based upon te, malpractic
services.
he best pri
ur gional
y
r network? es provide le.
otherwise ce history,
ice
E
Leunem If faopfu Unprcoonderislo Ex O Nthpr
M
mployer G
evel Funding nderwriting rmployee healt
your group avorable risk, ptimal solutioully insured pl
nlike fully iremium is “pommunity at nly pays forependents actsk of catastro
oss insurance.
xperience (sin
One Fixed M
o one likes suhat your montrogram term,
Many Level Fun
Your m
A p
We
Sp
If p
Stop
Once "r
roup Healt
self-insured preview and ath history stat
demographicthen a Level
on. However, lan could be th
nsured planspooled” to pa
large, your r the benefittually use. Leophic claims Why pay for
nce 1974) has
Monthly Pa
urprises, partthly paymentTCC returns
nding clients
monthly paym
ortion of your
e report to yo
pecific stop lo
plan benefits
p loss protect
run-out" is co
Level
th Risk Eva
plans abide byapproval of etements.
cs and healthFunding progif they are unhe better opti
s, in which ay catastroph
Level Fundints that yourvel Funding pmore efficienother groups’
shown that 4
ayment + Fu
ticularly on yo fully funds y100% of any le
tell us “heads
ent remains f
r payment fun
ou monthly th
oss insurance
s exhaust you
tion extends f
omplete, TCC
Fundin
aluation –
y different ruleach employe
h status indigram could b
nfavorable, thon.
the bulk of ic claims for
ng claim accor employees plans transferntly through ’ claims?
out of 5 empl
ull Accoun
our group heyour group heeftover claim
s you win, tail
fixed for 12 fu
nds a claim a
he exact amou
e reimburses
r account, the
for 6 months
returns 100%
ng Prog
Is Level Fu
les than fully er group, usi
icate be an hen a
the r the ount and
r the stop
loyer groups t
nting + Full
alth plan. TCealth plan witfund (surplus
s you break ev
ull months - o
account from
unt your acco
any individua
en aggregate
after plan ye
% of the accou
gram De
unding Rig
insured plansing an empl
typically qual
l Return of
CC Level Fundth no additios) directly to t
ven.” And hea
nly varies wi
which routin
ount paid out
al's large me
e stop loss ad
ear to cover a
unt surplus to
etails:
ght for You
s. Level Fundioyer applicat
lify for underw
f Unspent C
ding providesnal exposurethe employer
ads comes up
th enrollmen
ne benefits are
in benefits
dical benefit
dvances "over
ll "run-out" cl
o the employe
r Group?
ing plans are tion and par
writing approv
Claim Fund
s a 12-month . And after ea. It’s your mon
most of the ti
t changes
e paid
payments
draft" funds
laims
er
subject to rticipating
val.
ds
guarantee ach year’s ney.
ime.
Level Funding Benefit Plan Options
Plan # 1 2 3 4 5 6 7 8 9 10
Participating Deductible $1,500 $2,000 $2,000 $2,000 $2,500 $3,000 $3,000 $4,500 $5,000 $5,000
Providers Family Ded. $3,000 $4,000 $4,000 $4,000 $5,000 $6,000 $6,000 $9,000 $10,000 $10,000
Coinsurance 80% 100% 80% 70% 100% 100% 80% 70% 100% 80%
Out of Pocket $4,500 $4,000 $6,350 $6,350 $3,000 $3,000 $6,000 $6,350 $5,000 $6,500
Family OOP $9,000 $8,000 $12,700 $12,700 $6,000 $6,000 $12,000 $12,700 $10,000 $13,000
Non‐Participating Deductible $4,500 $6,000 $6,000 $6,000 $7,500 $9,000 $9,000 $13,500 $15,000 $15,000
Providers Family Ded. $9,000 $12,000 $12,000 $12,000 $15,000 $18,000 $18,000 $27,000 $30,000 $30,000
Coinsurance 60% 70% 60% 60% 70% 70% 60% 60% 70% 60%
Out of Pocket $13,500 $12,000 $19,050 $19,050 $9,000 $19,050 $18,000 $19,050 $19,050 $19,500
Family OOP $27,000 $24,000 $38,100 $38,100 $18,000 $38,100 $36,000 $38,100 $38,100 $39,000
Participating Primary Care $40 $35 $40 $35 $20 $40 $50
Providers Specialist $75 $50 $75 $60 $40 Deductible $75 Deductible Deductible $75
Copays Retail Clinic $40 $40 $40 $40 $40 and $40 and and $50
Urgent Care $75 $75 $100 $100 $75 Coinsurance $75 CoinsuranceCoinsurance $100
ER $250 $250 $500 $500 $500 $500 $500
Pharmacy Generic $10 $10 $10 $10 $10 $15 $15
Preferred $30 $35 $40 $45 $35 Deductible $45 Deductible Deductible $50
Non‐Preferred $50 $55 $70 $90 $60 and $85 and and $100
Specialty Rx subject to deductible 20% 20% 20% 20% 20% Coinsurance 20% CoinsuranceCoinsurance 20%
Mail Service 2.5x 2.5x 2.5x 2.5x 2.5x 2.5x 2.5x
Preventive services as required under the PPACA are covered at no out-of-pocket expense. Unless otherwise indicated, physician office copays includecharges for diagnostic tests, labs,imaging, pathology, radiology, supplies and injections associated with the physician office visit. Copays do not applyto the deductible. Copays apply to the Participating Providers Out of Pocket Maximum limits. Outpatient surgical, diagnostic, and therapeutic services,inpatient hospitalization, home health care, skilled nursing facilties, and durable medical equipment expenses are covered subject to deductible and coinsurance.
Precertification for non-emergency services is required, and penalties apply for non-engagement for imaging (PET, MRI, CT) $100, out-patient services $250, in-patient services $500.
All plans include Medical Advocate Program for cost-effective navigation through an episode of care, providing provider cost and quality information.All plans include Teladoc telemedicine services at no additional cost or copay. Teladoc is not insurance.All plans include US Preventive Medicine population health management program.
Phoenix PBM is the pharmacy benefit manager. Specialty Pharmacy benefits are subject to the plan deductible.
The Plan of Benefits document is the final determination of benefits. revised 11.06.2017
Part
* Elig
Ineli
Quo
Manmininot h
The
If the
ticipation
We requiof all elig100% of t
Participa
gible employ
igible and S
IneligiblMultiple Multiple AssociatiTaft-Har
Special CReligiousMetal/CoOil and GTobacco Explosive
te Requirem
ual quotes aimum life cohave to be co
following inf
Group Na Employee Desired P Desired S
e group has
Monthly p Detailed The curre Current a
aggregat
ire 75% of allgible employhe employee
ation will be v
yees are thos
Special Cons
le: Employer TrEmployer Wions
rtley Trusts
Consideratis Organizatioal Mining Gas Explorat
Stores and Pes
ments:
are availableounts. The raompleted in o
formation is
ame, Addrese Census to iPlan/ProducSpecific Ded
50+ employe
paid claims shock loss d
ent scheduleand renewal te factors, ad
l eligible* emyees participe premium, wverified thro
se full-time e
sideration G
rust Welfare Assoc
ion: ons
tion/ExtractiProducts
e for groupsates are conorder to rece
required to
ss(es), SIC. include birtht Designs anuctible and I
ees and expe
and correspata to includ of benefits trates, specif
dministration
mployees parpate in planwe require 10oughout the l
employees w
Groups/Ind
ciations
ion
s with 5-150 tingent upon
eive a quote,
receive a qu
h date, gendend PPO NetwIncurred/Pa
erience is ava
onding enrode details forto include plafic levels andn fee (with a
rticipate in ts for 51 or m00% participlifetime of th
who do not ha
dustries
lives withon the compl however the
uote:
er, coverage tork id Contract
ailable, the a
llment for thr all claims pan change ind contracts tll included s
the plans formore lives e
pation. he account.
ave coverage
EmployeProfessioHuman R
AsbestosLong HaCommerLegal SeMedical
out experienletion of enrey may be co
tier, city, sta
(Standard 12
additional req
he past 24 mopaid at or abnformation wto include spservices).
r 50 and feweenrolled. If th
e elsewhere.
ee Leasing Fional EmployResource Ma
s Products aul Trucking rcial Sports rvices Services
ce. Some strollment formompleted for
ate, employee
2/18)
quirements a
onths. bove 50% of thwithin the papecific and a
er lives enrohe employer
irms er Organiza
anagement C
ates may rems. Enrollmer a pre-qualif
e zip codes
are as follow
he specific dast 24 monthsaggregate pr
olled and 60%r contribute
ations Companies
equire higheent forms dofied rate.
ws:
deductible s. emium rates
% s
r o
s,