Group Health Plans

Group Health Plans

Midwest Group Benefits provides two basic types of health plans:
  • Fully insured health plans can be provided from a number of quality carriers.  The proper plan for you depends on your location, type of plan you desire and the flexibility you need.  With the fully-insured approach to health insurance you pay a premium which includes administration, reserves, company profits, claims and carrier fees.
  • Self-funded health plans work well for employers with more than 50 employees in any state.  We can administer a self-funded health plan that is protected with re-insurance for large claims.  Unlike the fully-insured plan, you only pay for claims incurred, administrative fees and reinsurance premiums.  For cost effectiveness and outstanding employee service, this approach is hard to beat.

Managed Care

Managed Care

Preferred Provider Networks

Midwest Group Benefits contracts with Midlands Choice to help our clients effectively manage the quality and cost of their health benefit program.

Midlands Choice is a regional preferred provider organization (PPO) with a healthcare network of more than 20,000 physicians and other healthcare professionals, 300 hospitals, and 1,300 other healthcare facilities.  By contracting with Midlands Choice, these providers agree to perform healthcare services at a reduced fee.  Consumers with coverage through one of our 150 payer partners have lower out-of-pocket costs for healthcare services when they use network providers.

If you would like more information on Midlands Choice, please visit their website at:
www.midlandschoice.com


Managed Healthcare Services
An international and independent leader in personalized managed healthcare, Hines and Associates provides the following on a contract basis to Midwest Group Benefits, Inc.

  • Pre-Certification
  • Utilization Reviews
  • Case Management
  • Disease Management


Hines' Specialty Case Management Overview:

  • BABEsm Maternity Management:  Targeted to women with special needs during pregnancy.
  • Dialysis Management Program: Renal/Dialysis nurses with an average of over 10 years of clinical experience.
  • Oncology:  Hines provides a family approach to case management during what can be a difficult and emotional time.
  • PsychiatricThe complexities of today's healthcare system are more easily navigated with the aid of our psychiatric specialty case managers.
  • Transplant ProgramCases are assigned early during the critical pretransplant period.  Hines' nurse specialists continue with the patient, providing continuity of care and expertise.

Pharmacy Management

Pharmacy Management
Midwest Group Benefits also contracts with MagellanRx, CVS/Caremark and NPS/National Pharmaceutical Service to provide our clients with a cost effective solution to pharmacy benefits.

Pharmacy Partners

At Magellan Rx, we're providing a smarter approach to pharmacy benefits. Our integrated solution combines our pharmacy benefit and specialty pharmacy expertise into an organization, allowing us to leverage our collective scale and experience in managing total drug spend, while ensuring a clear focus on the specific needs of each of our individual customers.  By truly understanding your needs, we empower you with easy-to-use tools and insightful cost savings solutions that improve member health and help you make more informed decisions.
  • Customer First Culture
    • Our strong focus on the customer will continue with an even greater emphasis on solutions and innovations that benefit our clients.
  • Trusted Scale and Resources
    • Magellan manages $15B in annual drug spend.  This adds additional scale and resources to the existing PBM efforts you've come to trust.
  • Unparalleled Experience
    • With over 40 years of Medicaid-focused experience, serving over half the nation's programs, our depth of health plan and State Medicaid experience gives you a highly-qualified team to manage successful implementations and ensure a seamless transition.
  • Integrated Specialty Pharmacy
    • We'll now be able to bring you an industry leading, patient-focused specialty pharmacy, featuring proven cost savings by integrating medical and pharmacy data for improved compliance and treatment outcomes.

At Magellan Rx, we provide proven cost-savings options, the knowledge for better decision making, and a partnership culture that uniquely adapts to the needs of our clients. It's an innovative pharmacy benefit approach that leads to more efficient cost control, improved outcomes and increased member satisfaction. 

Welcome to a unique vision of care.  Welcome to Magellan Rx.

CVS/Caremark provides pharmacy benefit management for plan sponsors seeking pharmacy and health care savings, better health outcomes and a more desirable plan member experience.  Plan sponsors and members have access to CVS Caremark mail service and specialty pharmacies and a network of approximately 60,000 retail pharmacies.

Together, Midwest Group Benefits and CVS/Caremark manage your prescription plan, benefit administration and eligibility.  They also perform ad hoc reporting and provide consistent customer care so that you can focus on your core business objectives.

Plan sponsors and members alike consistently give CVS/Caremark
high satisfaction scores:
  • 2009 client satisfaction: 98%
  • 2009 member satisfaction with mail pharmacy, Customer Care and specialty: 96% or better
Members can learn more about their prescription benefits by calling CVS/Caremark Customer Care toll-free or by visiting www.caremark.com

NPS/National Pharmaceutical Services  is a division of PTI, Pharmaceutical Technologies, Inc. formed in 1992 by a group of pharmacists in Omaha, Nebraska with an idea that was surprisingly simple:  change the way managed pharmaceutical healthcare operates. 

The top three reasons for choosing NPS/National Pharmaceutical Services as your pharmacy benefit provider are:
  • Value:  Services are priced fairly with no hidden transaction fees; Nationwide pharmacy network with 24-hour customer service and mail order program
  • Innovation:  Real-time reports; Custom designed plans; Claim activity tracking for more effective plan modeling
  • Trust:  Alignment with the "risk" entity, not pharmaceutical manufacturers; Data secure

And NPS/National Pharmaceutical Services also provides "Snapshot Reports" which are easy to understand; Clinical Program Services to assist clients in all aspects of plan; Communication to Members through the Prescription Drug Explanation of Benefits (EOB) report which assists members in determining level of accuracy of their claims and offers alternative drug products information.  To access the NPS website click here:  www.pti-nps.com




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