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Third Party Administrative Services

How Does Self-Funded Insurance Work?

Self-insured benefits provide the plan sponsor with a comprehensive yet economical method of providing health insurance to their employees. There are four distinct advantages to self-funding:
  1. Increased cash flow - you keep your cash until claims are incurred and need to be paid.
  2. Plan flexibility - self-insured plans have fewer state regulations and more flexibility in plan design.
  3. Potential plan savings - you keep your savings if you have a low claims year.
  4. Choice - through a thorough actuarial analysis, the employer always knows their annual maximum claims liability before deciding to self-insure.

Prompt, Accurate Benefits Administration

Vale-U-Health provides a full compliment of self-funding services including benefit plan design, provider network maintenance, claims administration, COBRA/HIPAA administration, stop-loss acquisition, utilization review and network management.

Specializing in Group Benefits for Health Systems

Our extensive expertise in self-funded health plans for hospitals and health systems enables your organization to enjoy a cost-effective, comprehensive benefit package through the development of a Home Host Program. With Home Host Programs, hospitals retain the majority of employee care within their facility and associated medical staff. Home Host Programs can reduce health insurance expenses while maintaining a comprehensive benefit plan by:

  • Increased cash flow - you fund your plan only when services are delivered;
  • Flexibility to choose your facility's reimbursement level;
  • Development of your own network to assure that your hospital and physicians are the primary source of care with a choice of secondary wraparound networks;
  • Benefits designed to direct your employees to your facility and physicians;
  • Integration of care and utilization management that effectively saves inpatient and outpatient health care dollars; and
  • On-site clinical care management for inpatient stays within the host facility and telephonic monitoring that effectively manages high cost outpatient diagnostics and services.

E-mail Susan Flynn at smf@vuhealth.com or call 1-877-264-8258 ext. 2402 to learn more about self-funding your Home Host Health Plan.

Claims Processing

We utilize a state-of-the-art software process in our fully-integrated claims system I-CAPS which is designed to handle multiple plan designs and lines of business with virtually no limitations. It combines pricing table, coding edits, rule sets and databases into a fully-integrated information system. Since implementing the I-CAPS smart system, claims turnaround time averages 3 to 5 days with superior accuracy and quality standards consistently maintained.

Customer Service

Hours of Operation:

8 a.m. to 5 p.m. Monday through Friday, EST.

24-hour messaging system available for after hour calls.

Our Automatic Call Distribution system promptly routes a caller to the next available representative, eliminating a lengthy wait for service.

Most calls are answered in 10 seconds or less.

Network

Within Southwestern Pennsylvania, the heart of our benefit plan is the VALE-U-HEALTH Provider Network, which includes:

  • Monongahela Valley Hospital
  • 140 Community-Based Primary Care Physicians and Specialists
  • Albert Gallatin Home Care & Hospice
  • Enduracare Orthotics and Prosthetics
  • Family Home Health Services
  • Mon Valley Community Health Services
  • Monongahela Valley Medical Supply
  • Orthopedic & Sports Physical Therapy Associates
  • OSPTA@Home
  • Rostraver West Newton Emergency Services, Inc.
  • Southwest Behavioral Care
  • Spartan Surgicenter
  • Valley Outpatient Rehabilitation

Nationally, we have access to a variety of statewide and national health networks that offer self-funded accounts competitive provider discounts from professional fees and rates.

What Other Benefit Options Are Available?

We offer a broad array of benefit options including medical benefit administration, care and utilization management services, prescription drug card programs, fully-insured dental and vision benefit programs and assistance with stop-loss acquisition and administration.

Is Self-Funding Right For My Company?

To find out if self-funding is right for your company, call our client representative at

724-379-4011 ext. 2402

and we'll arrange for you to meet with our specialist in self-funded health plans.

 
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© 2008 Vale-U-Health
724-379-4011, info@vuhealth.com