The Jefferson Health Plan is a legal organization requiring certain formalities for membership. As a result, potential members should become familiar with the steps required for membership and the duties of member employers before deciding to join the consortium.
There are several steps to be taken prior to becoming a member of The Jefferson Health Plan. First, for the consortium to prepare a cost analysis and rating proposal for an organization wishing to join the consortium, we need to review historical information concerning a plan's prior claims activity. This review will also require an examination of the historical plan design and enrollment. To ensure the analysis is realistic, the candidate organization should be prepared to provide two to three years of historical information.
Some of the minimum historical information required for analysis includes:
• Twenty-four months of the most recent paid claims by month and by line of coverage
(Medical, Dental, etc.), but only as related to the types of coverage considered for inclusion
in The Jefferson Health Plan pool;
• Twenty-four months of enrollment history broken down by month, by tier (i.e., Single, Family,
etc.), and by line of coverage;
• Large claims incurred in the latest twenty-four month period (in excess of $30,000) broken down
by claimant, including diagnosis/prognosis information on each of the large claimants;
• Stop loss coverage information, current deductible limits, premiums, etc.;
• Current historical monthly premiums paid by tier by line of coverage;
• Information regarding renewal rates by tier by line of coverage; and
• Current plan design along with a summary of any changes that have occurred during the prior
two- to three-year period.
Assuming that at least two years of the above information has been submitted to The Jefferson Health Plan for review and consideration, the following steps will occur:
• The proposed rate structure will be determined and communicated to the organization seeking
membership in The Jefferson Health Plan;
• Thereafter, a meeting takes place, usually at the applicant organization's offices, between the
candidate member organization and a representative of The Jefferson Health Plan when an
applicant expresses a continued desire for membership, at which time questions will be
• The member organization determines the desired coverage and selects an approved TPA;
• Collective bargaining unit negotiations occur (if necessary);
• The member organization signs a member agreement with The Jefferson Health Plan;
• Stop loss coverage is obtained for the group; and
• The Board of Directors votes on the membership of the applicant.
The success of The Jefferson Health Plan is due in part to its consistent application of funding techniques. Those techniques have been developed over many years, based on actuarially sound underwriting practices. To the extent that The Jefferson Health Plan is not able to apply its proven underwriting standards to a new member plan, suubsequent rate adjustments may be required.
Importantly, for new member groups, there are no up-front costs in joining the consortium. You simply pay the required monthly accruals, much like you would insurance premiums. Contact us today for more information on how to join!