NDHA Health Benefits Trust

The NDHA Health Benefits Trust is available to all its hospital members. For more information on the NDHA Health Benefits Trust please contact abrennan@ndha.org.

 

The NDHA Health Benefits Trust was established to help our members address the ever-increasing costs and challenges in providing health care benefits to their employees. Moving away from fully funded plans, the Association and members joined a growing number of employers in making the transition to a self-funded health benefit plan.

 

So, why are employers opting for self-funded health benefit plans?

 

Cost

A self-funded plan generally costs less than a fully funded plan. It decreases expenses such as taxes on premiums and administrative costs. Profit margins charged by insurance companies are eliminated.

 

Control

In a self-funded plan, claims are paid for as they occur whereas in a fully funded plan, the full premium is paid regardless of actual claims. If a substantial number of claims arise, stop-loss insurance kicks in to pay claims that exceed a certain threshold, ensuring protection for plan.

 

Flexibility

Self-funded plans are not a one-size-fits-all plan. Employers are not locked into off-the-shelf plans that are offered by insurers. Benefit plans can be optimized to meets the unique needs of employees and best suit the organization.

 

Transparency

More often than not, insurers keep the claims data in fully funded plans. Self-funded plans offer more transparency into costs and claims. Members can see the big picture and, with help from the trust administrator, be more proactive in implementing wellness, prevention, and alternative care programs for their employees.

Making the switch to a self-funded plan is a smart choice for employers who want to take back control of their health benefits and manage costs. By working together and pooling resources, members gain access more flexible large group health plan rules. They also gain improved leverage in negotiating health insurance premiums.

 

Transparency in Coverage Rule

 

The Departments of Health and Human Services, Labor and the Treasury previously finalized a Transparency in Coverage rule that requires health plans to create a patient-facing price comparison tool and post publicly available machine-readable files that include negotiated rates for covered services for in-network providers, historical payments to and charges from out of network providers for covered items and services and negotiated rates for in-network prescription drugs.

 

The price comparison tool is required to be delivered by January 1, 2023. In addition, the Departments have indefinitely delayed enforcement of the requirement to produce machine-readable files containing negotiated rates for in-network prescription drugs as the Departments are working to issue additional rules governing this requirement.

 

Machine Readable Files

The intent of this regulation is to provide health care pricing information that supports more informed decisions for receiving care.

 

BCBSND will provide the following machine-readable files, which are files where data is formatted in a way that can be processed by a computer, online:

 

  • In-network provider rates for covered services.
  • Out-of-network allowed amounts and billed changes for covered services.

 

BCBSND will provide public access to machine readable files that provide in-network provider rates for covered services. This information will be available effective July 1st by visiting the transparency in coverage page here.