Claims management program designed to save clients money with no additional obligation or process to go through. Our program uses a Reference-Based Pricing (RBP) Model resulting in fair claims payment, saving your company THOUSANDS in healthcare costs. Using various negotiation methods, the RBP Model stops healthcare provider price-gouging while remaining ERISA compliant.
As a strategic and beneficial cost control mechanism, Nexus incorporates a comprehensive health, wellness, disease management and prevention program which is clinically designed and proven to improve employee health, reduce health care costs, decrease absenteeism and presenteeism (in “attendance” but not focused) and increase productivity. The wellness and prevention program is a key element of the our health plan design since it is designed to assist employees and their families in maintaining and improving their health, which has the indirect benefit of reducing health care costs for both employees and employers.
Next after major hospital procedures, pharmacy drugs are the second highest expense in any group health plan. Our Pharmacy Benefit Management (PBM) program helps lower the over inflated cost of name-brand prescription medication by finding generic substitution, step-therapy, and over the counter programs that will be just as effective. Using this service will save a lot of money in prescription claims over the life of the plan.
Your company also has the option of including a Captive Layer to your claim fund. The Captive funding more-often-than-not results in a sizable dividend back to your company, tacking on even MORE savings.
Traditionally, when businesses provide employee medical insurance benefits, employees receive little more than an insurance policy issued by a particular insurance company which pays certain medical expenses in the event of illness or injury.
The created “health plan” becomes nothing more than a process of treatment, claims, and payments. Medical insurance alone is not a health plan.
Our proprietary health plan is not simply another insurance product, although insurance products are used. It is a multi-disciplinary, comprehensive and integrated health care strategy that provides employees and employers with improved health care coverage and benefits.
By understanding insurance companies and how they price risks, the innovative design of our health plan typically reduces health care benefit costs.