Medicare+ Major Medical
The 2020Choice Plan
The Boon Group solution to making self-funded group health plans efficient, affordable and sustainable.
The 2020Choice Plan offers a simple but comprehensive approach to resolve issues faced by employers such as:
- Rising insurance premium costs.
- Rising claims costs, especially on large claims.
- Over-charging by some providers.
- Ineffective PPO network discounts.
The 2020Choice Plan is the catalyst to continue the ERISA* employer-based health care system without the need for government-run programs by:
- Controlling premium costs.
- Controlling claims costs.
- Managing plan use.
- Using “reasonable and appropriate” provider reimbursements which allow the 2020Choice Plan to out-perform national insurance plans.
*ERISA, the Employee Retirement Income Security Act of 1974 as amended, provides federal legislation and regulations governing most employer-sponsored benefit plans
By using a reference-based* “reasonable and appropriate” approach as the basis for medical provider reimbursements, the 2020Choice Plan is able to provide a sustainable long-term fringe benefit solution to employers and their employees.
Reduction of Costs and Risks
- Reference-based** pricing reduces claims costs significantly while providers are fairly reimbursed.
- PPO costs are eliminated.
- Superior plan document with legal support and industry-preferred recovery services reduce costs and risks.
- Premiums and factors for stop loss coverage are reduced typically by 20-40 percent.
- Eliminate Rx generic copays.
- Provide coinsurance up to 100 percent.
**Reference-based – “reasonable and appropriate” amounts may be determined and established by the Plan, at the Plan Administrator’s discretion, using normative data such as, but not limited to, the fee(s) which the Provider most frequently charges the majority of patients for the service or supply, amounts the Provider specifically agrees to accept as payment in full through direct negotiation, average wholesale price (AWP) and/or manufacturer’s retail pricing (MRP), the prevailing range of fees charged in the same “area” by Providers of similar training and experience for the service or supply, and/or Medicare reimbursement rates 140 percent of CMS. Medicare rates plus 140 percent are generally considered to be the maximum payable rate, however, the Plan Administrator may in its discretion, taking into consideration specific circumstances, deem a greater amount to payable.