Health Plan Services

Our Customized Approach to Cost Savings

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Crumdale Specialty offers Health Plan Services with a customized approach to cost savings on level-funded, traditional self-funded and high performance captive financing options.

Partnering With Like-Minded Brokers for Success

Our goal at Crumdale is to partner with like-minded brokers to deliver simple solutions that provide significant cost savings for their employer groups. Our Health Plan Services promotes low costs with stability and security, maintains control with independent pricing, and leverages total platform volume for purchasing power.

Crumdale’s Health Plan Services are designed to meet you wherever you are on your journey.

CRAWL

WALK

RUN

Level-Funded Services

Health Plan Services provide level-funded health plans and consortiums and supports innovative and proven cost containment measures to reduce costs and create better experiences for employers and their employees.

The platform combines best-in-class components of an integrated health plan while offering dynamic and innovative solutions to achieve extraordinary results.

Self-Funded Services

Health Plan Self-Funded services are available to employers with at least 25 enrolled employees who are tired of double-digit renewal increases and see the advantages of buying into a multi-year approach designed to deliver savings, transparency, superior member experiences, and risk pooling. Our transparent and innovative program is ideal for fully-insured groups looking for more renewal stability with a structured approach to self-funding and self-funded groups that are experiencing significant increases due to lack of claims control.

High Performance Captive Services

Health Plan services also offers a turnkey high performance captive option, to provide a seamless experience for employers moving to self-funding. This solution offers built in cost containment strategies and is for employers size 25+ coming from level funded or size 100+ coming from fully insured. Additionally, the high performance captive has a no new laser and rate cap built in policy.

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Employer Groups

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Average First-Year Savings

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Average Renewal

Best-In-Class Health Plan Services

We make the complicated health benefits market easy to understand with turnkey solutions.

The Health Plan Services platform combines best-in-class components of a fully integrated health plan while offering dynamic and innovative solutions to achieve extraordinary results. Our expertise and leverage is what drives Crumdale’s distinctive outcomes.

TPA ADMINISTRATION

NETWORK SOLUTIONS

MEMBER ADVOCACY

DATA ANALYTICS

PHARMACY SOLUTIONS

STOP LOSS COVERAGE

HEALTH PLAN SERVICES

ACTUARIAL SERVICES

ERISA COMPLIANCE

REPORTING

RISK POOLING

CLAIMS MONITORING

PROGRAM MANAGEMENT

OUR INNOVATIVE APPROACH: FIVE CORE COMPONENTS

The word innovation gets thrown around often, but at Crumdale, we mean it. We’ve pioneered a new way to approach our Integrated Health Plans and we do so primarily through five core components:

Active Claims Monitoring
Independent TPAs
Custom Rx Programs
Group Purchasing Stop Loss
Member Advocacy & Support

ACTIVE CLAIMS MONITORING

We offer protection from high-cost medical claims due to fraud, waste, or abuse with our active claims monitoring. Our expert clinicians and in-house pharmacists analyze claims, identify errors and implement improvements for savings through experienced claims negotiation.

Expert clinician and pharmacist oversight
Real-time claims analytics
Cost saving intervention

INDEPENDENT TPAS

We partner with third-party administrators to customize plans and meet the needs of clients quickly and easily. With the strength of multiple networks, best-in-class partners, and back-end services, we deliver meaningful health statistics, immeasurable savings and better end-user experiences.

Strength of multiple networks and partners for competitive benefits and ensured coordination
Fast and smooth implementations with 19 pre-built plan designs, SBCs and SPDs to streamline the process
Stop loss and active claims review and monitoring to protect against unexpected high costs of care

CUSTOM RX PROGRAMS

Our in-house pharmacy benefits team provides continuous assistance for high-cost claims management and high-cost drug strategies. Our proprietary PBM relationships support specialty drug management and pricing validation to help identify and implement solutions to cut unnecessary costs.

In-house pharmacy benefits experts with cost saving solutions
Continuous high-cost claims management
Continuous high-cost drug support

GROUP PURCHASING STOP LOSS

Crumdale provides a strategic approach to underwriting so clients can leverage our global volume for access to leading rates, terms, and discounts. This type of underwriting also promotes long-term financial success by promoting strategic planning.

Stop loss leverage provides favorable discounts, terms, and conditions
Pooled arrangements significantly decrease renewal volatility
Allows for strategic planning around a long-term financing strategy

MEMBER ADVOCACY & SUPPORT

To ensure clients get the most out of their benefits, we offer ongoing benefits navigation and HR support to improve utilization for employers and employees. We use technology-enabled tools with proprietary data analytics to navigate the best health options, improving member experiences.

HR Support for employees to improve health benefits navigation
Review medical bills to ensure members are not overpaying
Industry leading member support to answer questions and solve issues

Our Value Proposition

When you join the Crumdale Specialty network you gain leverage to reduce employee benefits costs, plus exclusive access to:

Turnkey, transparent solutions that are easy to understand
Industry subject matter expertise and local market knowledge
Creative cost containment strategies
Superior contracts
Best-in-class vendor and carrier relationships
Alternative risk financing and management
Expert data analysis, actuarial and compliance support
Agile solutions tailored to meet your needs

Success Stories

Additional Solutions for Ongoing Savings

To provide additional support for each and every health plan, we combine our core components with the appropriate advanced initiatives to supercharge the plan and achieve even more significant cost savings.

We implement additional advanced initiatives individually, on a case-by-case basis, when it makes the most sense for a client and their plan.

ADVANCED INITIATIVES FOR COST CONTAINMENT

Specialty Drug Management
Incentive-Based Plan Designs
Pre-Pay Cash Services
Customized Plan Document Language
Population Health Management
Direct Primary Care
Direct Contracting
Bundled Surgical Procedures
Transplant Networks
RBP & VBP
Narrow Network

Quoting

Partnering With Like-Minded Brokers

Crumdale works with brokers to help them win and retain more business using Crumdale’s Health Plan Services.

We take a collaborative and consultative approach when it comes to plan development but handle all of the fine details behind the scenes so you can focus on what you do best – managing clients.

Short-Term & Long-Term Support

Short-Term & Long-Term Strategy: Renewal Expectations & Goals
Quoting: Risk Analysis & Quote Delivery
Implementation: Vendor Notification & Plan Build
Ongoing Support: Claims Review & Risk Analysis

Quick Turnaround for a Stop Loss Quote

25 (Minimum) Employees Enrolled
Individual Stop Loss
Aggregate Stop Loss
Spec. Advance
Aggregate Accommodation

Fast & Efficient Quoting Process

Crumdale will run through an actuarial modeling tool that will provide “illustrative” rates. These rates serve the purpose of “qualifying” the employer group.

If the rates are competitive, the group is a good candidate and should consider moving through the IMQ process. We offer a 2 – 3 day turnaround for Dependent Level Census, Benefits Summaries, and Current Rates.