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.
Preferred Provider Networks
Midwest Group Benefits contracts with Midlands Choice
and Gundersen Lutheran
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.comGundersen Lutheran
is a preferred provider (serving western Wisconsin, southeastern Minnesota, and northeastern Iowa) with multiple clinical locations throughout the Tri-state area. In addition to Gundersen Lutheran Clinics, Gundersen Lutheran Medical Center is a 325-bed hospital with the area's only Level II Trauma Center and Neonatal Intensive Care Unit. At Gundersen Lutheran, Primary Care services are supported by one of the nation's largest multi-specialty group practices. Gundersen offers a a model of care called, "Medical Home", an ongoing relationship with a primary care physician and team who provide a coordinated, comprehensive approach to caring for you and your family.
If you would like more information on Gundersen Lutheran, please visit their website at:www.gundluth.org
*Midwest Group Benefits can work with other PPO's as desired.
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.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.
- Psychiatric: The complexities of today's healthcare system are more easily navigated with the aid of our psychiatric specialty case managers.
- Transplant Program: Cases are assigned early during the critical pretransplant period. Hines' nurse specialists continue with the patient, providing continuity of care and expertise.
Midwest Group Benefits also contracts with CVS/Caremark
, NPS/National Pharmaceutical Services and PartnersRX
to provide our clients with a cost effective solution to pharmacy benefits.Pharmacy PartnersCVS/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
NPS/National Pharmaceutical Services
Members can learn more about their prescription benefits by calling CVS/Caremark Customer Care toll-free or by visiting www.caremark.com
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