Introducing The Difference Health Plan
A New Self-Funded Health Insurance Solution for Small to Mid-Size Businesses
Moving from a fully insured health plan to a self-funded one can be daunting. It’s intimating to take on the risk of full claim exposure.
With The Difference Health Plan, you get complete confidence that we will guide you or your client to the right self-funded plan design.
The same level of dedication and knowledge that you have come to expect from The Difference Card will be present in every decision you make with The Difference Health Plan.
The Difference Health Plan Advantage
Innovation, customization, and specialization is in the very DNA of The Difference Health Plan.
We use a proprietary platform with deep expertise in building custom solutions. Just like The Difference Card, The Difference Health Plan can accommodate complex plan designs and account structures.
The Difference Health Plan has a robust vendor connectivity system. We can connect to more than 150 vendors including Carrier Networks, RPB Vendors, Pharmacy Benefit Managers, and Concierge Services.
Want to learn more about The Difference Health Plan?
Why should you consider going self-funded?
Savings are built into the plan design:
- The premium tax you pay is lower than other health insurance options
- The prescription rebates go to the employer NOT the health insurance carrier
- Administrative fees on average run about 12% less than fully insured health plans
- The savings achieved by The Difference Health Plan are used to fund the claims costs
Plan administration is streamlined:
The Difference Health Plan takes care of everything. The plan functionality that is typically handled by the Insurance Carrier is taken over by The Difference Health Plan which allows for more control and greater service levels.
Large claim protection & max liability coverage:
- The Difference Health Plan is protected by reinsurance. If a claim exceeds the agreed upon amount, the employer is not responsible for any amount of the claim limit.
- Aggregate stop loss insurance protects the employer against total claims incurred by the entire organization.
What is built into The Difference Health Plan?
The components of The Difference Health Plan are similar to most self-funded solutions but have been hand-picked by us to ensure the highest level of quality and success.
With The Difference Health Plan, you will get:
- Cost Containment Solutions
- Transparent Pharmacy
- Integrated Consumer Account Options
- Peace of Mind with Stop Loss Protection
- Online Enrollment & Compliance Management
- Unparalleled Customer Service
Cost Containment Solutions
Cost containment is at the heart of The Difference Health Plan.
National Network Partnerships
We work with National PPO Networks to provide the very best options to you or your clients. Our National PPO Networks focus on cost, quality and improving the member experience with their health insurance provider.
For our In-Network Providers, you:
- Get the contracted provider rates
- Can receive 50% or more in provider and facility discounts
- Will never be balance billed
For our Out-of-Network Provided, you get:
- Medical bill negotiation
- Precision claim reviews
- Established reimbursement levels
Care Navigation
Our care navigation tool delivers a new standard of care through clinical expertise that is uniquely informed by member data.
Included in our Care Navigation Tool:
- An intuitive app that serves as the central hub for all healthcare and benefits information for members.
- Personalized and dedicated care teams for each member including a clinical lead, health guide, billing specialist, mental health specialist, and a pharmacy specialist.
- Tools to engage and educate members with onboarding of new members, proactive outreach
The impact of our Care Navigation Tool:
- 15% lower healthcare spend by members
- 41% member engagement rate
- An 84 Net Promoter Score for this tool
Transparent Pharmacy Options
Our Difference Health Plan Pharmacy Coalition brings deep discounts, managed specialty medications and a 100% rebate share. After extensive research with over 20 PBMs, we selected three preferred top tier PBMs to deliver transparency and the best price for our clients.
The Difference Health Plan Pharmacy Coalition provides:
- More transparency
- Lower pharmacy costs:
- Increased flexibility
- Detailed reporting
- Stronger contracts
With The Difference Health Plan Pharmacy Coalition, we have created a Prescription Drug Benefit Program that offers superior clinical and financial offerings, which creates significant cost savings for clients.
Embedded cost containment features include:
- Clinical protocols and programs
- Real-time review of high-cost and specialty medications prior to payment
- Patient and Manufacturer Assistance Program for select Specialty medications
- A 340b Pharmacy Program for 20/30% savings
- A Telehealth Specialty pricing program
- Management of non-specialty medications through state-of-the-art member engagement therapeutic substitution program
Integrated Consumer Account Options
The Difference Health plan can work together with our Difference Card. With The Difference Card, you can load multiple Consumer Accounts onto the card – making it easy for members to access their funds.
The Difference Card can serve as a one-card solution for:
- Medical Expense Reimbursement Accounts
- Health Savings Accounts
- Health Reimbursement Arrangements
- Flexible Spending Accounts
- Dependent Care Accounts
- Lifestyle Spending Accounts
- Commuter and Transit Accounts
- Healthy Difference Wellness Incentives
Peace of Mind with Stop Loss Protection
The Difference Health plan gives you access to top rated carriers to manage the risk associated with a self-funded arrangement.
Our carrier partners can protect you from large claims and put an overall maximum on your healthcare claim liability.
The Difference Health Plan offers both level funded and traditional corridor self-funded stop loss arrangements. A snapshot of some of our stop loss carrier partners is listed below.
| Stop Loss Carrier | A.M. Best Financial Rating |
| American Fidelity | A+ |
| Anthem | A++ |
| Berkley A&H | A++ |
| Berkshire Hathaway | A++ |
| HMIG | A |
| Optum Health | A |
| QBE Insurance | A |
| Sun Life Financial | A++ |
| Swiss Re | A+ |
| Symetra Financial | A |
| TMHCC | A++ |
| Unum | A |
| Voya Financial | A |
Online Enrollment & Compliance Management
With The Difference Health Plan, you get access to our Benefit Administration System!
The Difference Benefits Admin System is a comprehensive suite of products including our online enrollment services platform, an HR Portal, COBRA Administration, and our interactive benefit decision guide: DANNY!
Learn more about The Difference Benefits Admin system HERE.
Unparalleled Customer Service
Our Member Services Team is filled with knowledgeable representatives who can assist members with any questions they may have and will help them gain a better understanding of how their benefits work.
Our goal is a best-in-class experience for our clients.
Your assigned Account Manager is held accountable to YOUR experience. Our Customer Loyalty Score is in the Excellent category with a Net Promoter Score of 53.
Our Member Service Team is ready to help:
- We support your employees from 8 AM to 9 PM ET with helpful and compassion associates.
- We offer 24/7, 365 days a year automated phone support.
- We are available to help employees through phone support, email and live chat.
- We keep wait times low. Our Average Speed of Answer when calling Member Services is less than 45 seconds.
- Check out what our clients are saying.
Interested in learning more about The Difference Health Plan?
To learn more about how The Difference Health Plan can ease the transition from fully insured to self-insured, contact your Sales Representative or request a proposal today.