EHIM Announces Self-Funded Program


SOUTHFIED — For more than two decades, EHIM has remained committed to offering innovative health care solutions to organizations and businesses across the country.

Despite the speculation of what 2015 will bring, EHIM officials say they will continue to offer customized pharmacy programs that provide hands on clinical management, which result in significant cost savings to our clients.

The EHIM Cares program has saved clients over $3M since its inception in 2011. EHIM encourages all clients to take advantage of the transitional rules that apply in 2014 with respect to “carve-out” (despite what is being communicated by many insurance carriers). In addition to the financial savings that can be achieved with a self-funded pharmacy benefit, there are other benefits to a client and their members with pharmacy “carve-out”:

  • In 2014, as EHIM understands under the Affordable Care Act clarification FAQs that were issued in February, plan sponsors are not required to implement a maximum out of pocket accumulator for the pharmacy program, if the pharmacy benefits are administered by a separate vendor than your medical benefits and the group does not currently have a maximum out of pocket in place.
  • With a self-funded prescription benefit program, groups are generally not obligated to meet the “metal” plans nor are they mandated to include all “essential” health benefits.
  • The new “insurance tax” under the ACA is not assessed on self-funded benefits. This “insurance tax” will only be assessed to fully insured plans and is estimated to be between 2 – 4 percent of the premium.
  • With a prescription carve out, it provides the client two independent sets of data to analyze their overall health care package and compare and contrast the utilization trends and patterns reported by each for verification and validation of one another.

The client can consolidate and offer one prescription benefit to all employees, regardless of the medical program. With a “carve-out,” the medical benefit does not have to dictate the prescription coverage that is provided. As always, EHIM encourages all clients to consult with their benefit advisors on how various aspects of the Affordable Care Act  may impact healthcare offerings.