Hi All,
I spoke with Sarah at Apta about the Samaritan Fund outlined below as a new option for our members earlier this morning.
This plan would be sent out to our entire group as an option. After this, the member would sign up for the no-cost to them plan. If they qualify - based on disease or condition - they would then move to the plan for the one-year period. There is no guarantee that they would qualify for the following year.
It is potentially a great way to mitigate the cost to our plan, as the plan would have lower upfront cost ($55k per member with $15k per each dependent) and no claim expenses. This could also lower our stop loss.
However, the member is put on another plan in which we have no control over. This means they could not call me to help with an issue. This means that you, as a board, could not make an exception to the plan - not that you would, but in those rare cases.
I have requested a contact with another plan who is currently utilizing this Samaritan Fund to discuss the pros and cons of adopting this option.
Naturally (I think), I am apprehensive about adopting this based on the unknown. After the Reference Based Pricing disaster with TBG, I am not totally comfortable in anything non-traditional. This does not mean that I would not adapt and accept a decision to move forward, it just means that I want you and our members to be cautious and well informed.
Call me if you want to discuss further and also note the deadline of 10/31/24 for the decision.
Thank you,
Tara
Tara Johnson
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________________________________
From: Sarah Thielen AH <sthielen(a)Apta-health.com>
Sent: Wednesday, October 16, 2024 10:44 AM
To: Tara Johnson <tjohnson(a)netroopers.org>
Cc: Tim Longwell <tlongwell(a)theolsongroup.net>; Howard Shandell <hshandell(a)theolsongroup.net>; Ryan Thiess <rthiess(a)novoconnection.com>
Subject: Samaritan Fund Information
Hi Tara,
I’m looking forward to our meeting next week! As we discussed, I wanted to provide some additional information regarding the Samaritan Fund program. This is a program that we are recommending to groups for 2025 as it could help current members, but also members not yet on our radar should the come on to the plan after open enrollment due to status change. I’ve detailed some items regarding the program below and attached the informational flyers. The program does have a deadline for applications of 10/31/2024. There is not PEPM for this program and is nice to have in the background should need arise due to a status change or during the annual open enrollment period. If a member applies and is accepted, the group makes the ultimate decision on whether or not they’d like to move forward (case fee is bolded below).
The implementation of this program requires a signed agreement, and a brief implementation call with Samaritan Fund. The Samaritan Fund provides detailed communication materials and email templates that can be sent to members.
A few other points to note:
• This is a risk mitigation tool and resource for employees – it removes financial burden for both the group (plan) and individual
• Engages those who need help and provide options outside of their group health plan
• Win-win – cost associated with a member’s high claims exit the plan, leaving employer with significant cost savings
• Participants no longer burdened by premiums, deductibles and maximum out-of-pocket costs
• This program is voluntary and no cost to implement; fee is only charged if they are successful in finding an acceptable solution for qualified candidates
• Eligibility is open to all employees and dependents, but target are members who expect over $50,000 in claims
• It is an application process, but there is no income requirement – acceptance is based entirely on the types and severity of medical conditions that they are suffering with
• They use predictive modeling and clinical information to determine if an applicant meets the criteria
• Once accepted, the member waives coverage under the employer group health plan at Open Enrollment
• Members can only apply for the program at Open Enrollment or when a life event occurs (i.e. preemie baby)
• The goal is to leave members with little to no out-of-pocket expenses
• The source of funding is from third-party Samaritans who contribute to the Samaritan Fund, which is a 501c3 charity
• Once funding is determined, they ‘round up’ amount to help members with existing medical debt and items that insurance may not cover
• Funding is individualized for a particular member’s situation and delivered on a Samaritan Fund Visa debit card – all at once, on day 1. (They narrow the eligible merchant class codes to prevent inappropriate use of funds, much like an HSA or FSA card.)
• The Samaritan Fund consultants work very hard to find a health plan that ensures there will be no disruption to care, members can keep their same doctors
• 60-90 days prior to the next Open Enrollment, the Samaritan Fund will evaluate member’s circumstances to determine if they continue to qualify for the next year
• $55,000 = consultant fee payable to The Samaritan Fund. If it is necessary to bring any dependents with the member, each dependent = $15,000 additional fee (to a maximum of $100,000)
Thank you,
Sarah
Sarah Thielen
Lead Client Experience Executive
Apta Health | Novo Connection
628 N 108th Court | Omaha, NE 68154
402.999.4478 direct | 402.707.9786 mobile
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