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:
- Increased cash flow - you keep your cash until claims
are incurred and need to be paid.
- Plan flexibility - self-insured plans have fewer state
regulations and more flexibility in plan design.
- Potential plan savings - you keep your savings if you
have a low claims year.
- Choice - through a thorough actuarial analysis, the employer
always knows their annual maximum claims liability before deciding to
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
- Increased cash flow - you fund your plan only when services
- 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
- Benefits designed to direct your employees to your facility
- 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 firstname.lastname@example.org
or call 1-877-264-8258 ext. 2402 to learn more about self-funding your
Home Host Health Plan.
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
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.
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
- 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
Is Self-Funding Right For My Company?
To find out if self-funding is right for your company, call our client
724-379-4011 ext. 2402
and we'll arrange for you to meet with our specialist in self-funded health