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Employer CHAMP Plan Overview
Employer CHAMP Plan Introduction:
The CHAMP Plan™ is a self-funded, personalized, clinical preventive healthcare program that has been designed to complement an organization’s primary healthcare insurance in such a way that it makes the organization’s healthcare coverage highly cost-effective and beneficial in terms of employee retention and satisfaction rates.
Employer Benefits
Retaining key employees is essential to every business, and a company’s health benefit program is a key part of the compensation they offer to their employees. Due to the rising costs of traditional employer-sponsored health insurance, U.S. employers are steadily dropping those plans in favor of defined contribution health benefits. Rather than paying the costs to provide a specific group health plan, employers might want to consider a self-funded plan.
A self-funded plan can solve the employer’s as well as the employees’ problem related to the cost-effectiveness of healthcare insurance as it has the following benefits over traditional healthcare insurance:
The employer can customize the plan to meet the specific health care needs of its workforce, as opposed to purchasing a “one-size-fits-all” insurance policy.
The employer maintains control over the health plan reserves, enabling maximization of interest income – income that would be otherwise generated by an insurance carrier through the investment of premium dollars.
The employer does not have to pre-pay for coverage, thereby providing for improved cash flow.
The employer is not subject to conflicting state health insurance regulations/benefit mandates, as self-insured health plans are regulated under federal law (ERISA).
The employer is not subject to state health insurance premium taxes, which are generally 2-3 percent of the premium’s dollar.
The employer is free to contract with the providers or provider network best suited to meet the health care needs of its employees.
Employer FAQ
Do I have to change insurance?
No. The CHAMP Plan™ is a self-funded overlay program that supplements existing traditional medical insurance plans.
Do employees need to change providers or medical care?
No. Employees who voluntarily enroll in The CHAMP Plan™ can continue to use the same providers and receive the same medical care they’re already receiving through their traditional medical insurance. The CHAMP Plan™ can provide additional options for better quality care and cost savings as identified by the physician of record, but employees are not required to take those options.
Why did my employee’s paycheck go up?
Each pay period, a pre-tax deduction comes out of each employee’s paycheck to help fund the employer-sponsored CHAMP Plan™. The typical taxes are then taken from the now reduced pre-tax pay, and employees receive a post-tax benefit after participating in a monthly healthcare activity that triggers a CPT code and explanation of benefits. (Triggers are as simple as watching a video or reading an article).
In short, a lower adjusted gross income results in lower taxes, which raises an employee’s take-home pay after The CHAMP Plan™ post-tax benefit is added to their paycheck!
How do I implement this plan to my employees?
Schedule an appointment and once you send us a copy of the census, we can begin to identify your potential savings per employee.
What benefits are included?
Unlimited access to Concierge’s advocate approach to health care.
It’s having a doctor available 24/7 at your beck and call.
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Can we begin participating in the program at any time?
Yes, and every month you wait, you’re losing out on potential FICA savings per employee!
What prescriptions are covered?
A robust list of nearly 200 generic and brand name prescriptions is covered by The CHAMP Plan™, including many of the nation’s top-prescribed drugs such as simvastatin and atorvastatin for high cholesterol, amlodipine and lisinopril for high blood pressure, levothyroxine for hypothyroidism, and bupropion for tobacco cessation, as well as antibiotics like azithromycin and amoxicillin, pain management medications like gabapentin and meloxicam, and mental health medications like lorazepam and clonazepam (see formulary list for full details).
Prescriptions not on the list may also be covered at a significant discount.
Is The CHAMP Plan™ compliant?
Yes. The CHAMP Plan™ is a qualified Section 125 plan set up as a self-funded employer-sponsored plan that is 100% funded by employees through a pre-tax payroll deduction. The amount deducted represents the maximum claims for the policy year. The third-party administrator (TPA) holds the monies in a custodial account and pays claims as they incur in accordance to the plan document and the schedule of benefits. The definition of a claim is defined as claims made to providers, facilities, pharmacies, or employees.
Claims to employees result when an applicable CPT code is triggered with a corresponding explanation of benefits (EOB). Examples of these claims include preventive examinations, bio-metric screens, health risk assessments, and chronic medication fulfillment. Claims made to employees are neither taxable nor considered ordinary income. The amount of premium charged to employees is actuarially set to cover the claim risk on the plan while meeting a desired medical loss ratio (MLR). At the end of the plan year and the runout period, any potential surplus left in the claim account is considered a plan asset to the employer.
Does The CHAMP Plan™ meet the definition of Minimal Essential Coverage (MEC)?
The CHAMP Plan™ meets the definition of an MEC for the individual mandate, but is not sufficient from an employer’s perspective.
