Below are a list of questions we hear most often. If you have a question that is not listed below, feel free to contact us.
What is Health Partners to businesses and organizations?
Northeast Georgia Health Partners is a preferred provider organization (PPO) based in Gainesville, Georgia. The network is the result of the combined efforts of community based physicians and hospitals seeking to provide exceptional health care in their local market. Established in 1994, the network has grown to include over 1000 providers, 9 hospitals and over 80 ancillary service providers.
Why choose Health Partners?
Health Partners offers solutions to the challenges of rising costs and complexities of healthcare. A partnership with Health Partners provides an employer access to high quality, competitively-priced healthcare. The network also offers “one-stop” contracting for access to a statewide network of physicians and hospitals. Additionally, it offers a variety of ancillary services such as Disease Management and Pharmacy Benefit Management designed to reduce healthcare costs and improve employee wellness and engagement.
Is Health Partners an insurance company?
Health Partners is not an insurance company. They do not administer or re-price insurance claims. Simply stated, Health Partners is a PPO network which arranges for the delivery of healthcare services in its local communities. Help is available however, for those customers who need assistance in developing an insurance product to meet specific needs. Health Partners has preferred relationships with third party administrators (TPAs) and other resources to design a “turn-key” program for almost any employer.
How can I find out if a doctor or hospital is participating in Health Partners network?
Health Partners has a comprehensive list of in-network providers and facilities. With over 1000 providers, 9 hospitals and 80 ancillary facilities, accessing a Health Partner provider is easy. Click the Provider Search tab or call member services at 770-219-6600.
How does an employer access Health Partners network?
Health Partners contracts with insurance companies and third-party administrators. These carriers and claim administrators have access to HP providers.
Are there a minimum number of employees per group required to access Health Partners products?
No. We have products available for individuals and for groups with two or more employees.
Does Health Partners allow third party administrators (TPA’s) to re-price claims?
Yes. Health Partners prefers to let third party administrators do what they do best, re-price and pay claims. HP does not re-price claims for its customers.
Does Health Partners have physician and hospital coverage outside of their service area?
Yes. Through affiliate network relationships, HP has access to physicians and hospitals all over Georgia and beyond. Health Partners primary goal is to offer employers and third party administrators a complete network solution. That is, a single source for all provider services needed on a local and regional basis to support the typical employee benefit plan. The Health Partners network is commonly combined with our affiliate network, PHCS for expanded state-wide coverage or it can be combined with other PPO networks depending upon the unique need of the health plan.
What about self-funding?
In 1974, the Employee Retirement Income Security Act (ERISA) was passed allowing employers an alternate means of funding their medical and other employee benefit plans. Self-Funding provides an alternative to the high cost of fully insured benefits plans, flexibility of plan design and the potential for savings.
A self funded plan is divided into two distinct segments:
- Fixed costs – Administrative fees, stop loss premiums, network costs and claims management costs.
- Claims funding – Funding for actual claims. These funds are held in the plan’s claims account until needed.
The claims account works in conjunction with stop-loss insurance protection, which limits the plan’s liability against large claims. Stop-loss coverage falls into two categories: specific and aggregate. Specific stop-loss coverage limits the employers liability on any individual covered under the plan for the plan year. Aggregate stop-loss coverage limits the annual claims liability on all members for the plan for amounts under the specific stop-loss coverage.
Advantages of Self Funding
A self-funded (or self-insured) health plan is one in which the employer assumes some or all of the risk for providing health care benefits to its employees. The employer takes control of the assets of the plan, invests them to its advantage, and eliminates the insurance company charges. The employer becomes the fiduciary. The advantages of self funding are:
- Self-funding provides the potential for savings if an employer has good claims experience. In cases where claims exceed expectations, the employers liability is capped under the stop-loss protection built into the plan.
- Self-funding provides employers the ability to customize their plan designs to meet specific needs of the group. This differs from traditional, fully-insured programs where employers have no flexibility with the plan design benefits.
- By using a self-funded plan in conjunction with Health Partners, your company maximizes its potential for overall savings by accessing healthcare at competitive prices.
- Self-funding provides the ability to add Disease Management programs and creative Pharmacy programs designed to reduce costs.
- An employer doesn’t pay state premium taxes, which usually range form 2% to 3% of the monthly insurance premium.
- Self-funding will show a large first-year savings through the lack of premium taxes, various insurance company charges, and first year claim lag. This excess reserve can be used in future years to offset health plan increases.
- The employer retains control over the health plan reserves, enabling maximization of interest income. Self-funding offers cash flow advantages not found in fully insured arrangements. Also, an employer only pays for the claims incurred during the contract year. The coverage is not prepaid, thereby again, improving cash flow.