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Large Claim Reimbursement

LARGE CLAIM REIMBURSEMENT PROGRAM

The most economic and efficient way to purchase healthcare benefits for your public sector employees is to self-fund your health benefits plan. With the savings of self-funding of benefits plans comes the risk of unknown, potentially large claims. This unknown claim risk can be intimidating for some public entities.


Traditional self-funded plans reduce large claim risk through stop loss insurance. But stop loss insurance can often be volatile for the small to mid-size employers. Stop loss carriers may attempt to shift risk to the employer, avoid risk on ongoing claims, or recoup losses at renewal each year.


The Jefferson Health Plan Tennessee Healthworks program offers a powerful solution to mitigate the risk of unknown, potentially large claims. The JHP Tennessee Healthworks Large Claim Protection Program (LCRP) enables public entities of all sizes to purchase coverage for large claims as part of a 25,000-employee group. The size and financial strength of the LCRP brings funding stability, eliminates selective underwriting at renewal (lasering), contains no commissions, no profits margins or share-holder responsibilities, no overrides, and no premium taxes. An individual public entity's large claim experience is blended with the entire LCRP group. No member organization is left to stand alone at renewal. All there features bring plan savings at each renewal.

Here is how it works. JHP  Tennessee Healthworks program will underwrite each group based on provided information. Member organizations are given a monthly LCRP funding factor. The LCRP fixed fee is based on the risk level chosen by the group and ranges from $50,000 to $250,000 in $25,000 increments. All claims up to the pre-determined risk level are the responsibility of the employer. The claims above the risk level are paid from the LCRP account which is funded by all JHP Tennessee Healthworks program members. Each member organization has full coverage for large claims even if the amounts exceed the member organization's funding. No member organization will ever be asked for additional LCRP funds during the plan year. All eligible large claims are paid without any impact to the member organization's health plan budget.

The Jefferson Health Plan Tennessee Healthworks program purchases large claim protection at a much higher level for the entire group. The cost is included in the set LCRP funding factor.

At renewal, the entire 25,000 subscriber group is rated, and the rating is applied to all member organizations based on risk level and underwriting guidelines. Individual member organizations are now renewing their large claim protection similarly to that of a Fortune 500 company. The Jefferson Health Plan Tennessee Healthworks Large Claim Protection Reimbursement Program mitigates risk and provides savings and stability to all its member organizations.

To find out how your public entity plan can start saving, please contact Brendan Nugent at [email protected], or by calling 740.792.4010 ext. 203.
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