Membership
Why should I join the Business Health Care Group (BHCG)?
As the voice of the business community, representing both small and large employers, we’re able to influence health care costs and quality in our region. Membership helps employers manage escalating health care costs and provides employees access to more efficient and effective health care services.
Business Health Care Group (BHCG) membership gives fully insured employers exclusive access to Humana Preferred SM plan offerings tied to a high performance network. Members benefit from the combination of BHCG buying power and the efficiency and quality standards of Humana. In addition, members have their own dedicated team of specially trained billing, enrollment, claims and customer service representatives along with an 800 number exclusively for Humana Preferred (BHCG) health plan members.
BHCG membership is a valuable resource for smaller employers who must wear many hats. The program offers resources, tools and information that can be critical to your success in managing your health care costs.
How is this different from other approaches?
Employers in our region struggle to offer affordable health plans that motivate employees to get healthier and make informed health care decisions. More than just a network, BHCG represents a long-term strategy for employers who are tired of searching for solutions every year.
Small and large employers from across the region are collaborating with health care providers and their employees to support a common strategy – one that seeks to improve health care delivery in our market. Together, we are developing and acquiring valuable tools and resources and creating market driven initiatives that reduce costs and improve quality.
When am I invoiced for BHCG membership?
Membership in the BHCG is payable annually on a calendar year basis. All BHCG employers will receive a BHCG membership invoice in December for the following calendar year. Membership dues are not tied to your plan’s effective date. For example, if you joined the BHCG with an effective date of June 1, you would still receive a BHCG membership invoice in the fall of that same year for membership for the next calendar year.
Who can join BHCG?
Employers of all sizes can join the BHCG independently or through a sponsoring organization such as a chamber of commerce.
What plan offerings are available for fully insured employers?
A wide variety of plan options are available for fully insured employers of every size, including sole proprietors. Plan design options include both traditional and consumer directed health plans. Ask your broker or consultant for more information about the Humana Preferred plan design portfolio for fully insured employers.
Plan Information
Will I be pooled?
Humana does put all fully insured employers into a separate pool specific to the BHCG. This pool allows Humana to track trend separately and apply a lower trend – both at the initial offering and at renewal for BHCG members.
How will my premium be calculated?
On Humana‘s initial quote, premium is calculated based on a group’s census/demographics (i.e., average age, gender, type of contract – single, family, etc.), the location of the business, the type of business and the plan design selected. All these factors are taken into account to create a base (manual) premium rate for an employer group. These base rates are not considered final.
To receive final premium rates, a group must complete the underwriting application process. For groups with two to 50 employees, Humana is required to underwrite the case and the universal application is used to finalize rates. Based on underwriting review, these premium rates may remain the same, or could increase. Once final premium rates are set, Humana is required to provide guarantee issue of the plan offering.
For groups with 51+ employees, Humana is required to do limited underwriting via the application. Humana maintains the rights to hold base rates, apply a load to the rates or decline coverage.
How does membership in the BHCG affect my premium
In two ways: first, Humana uses a lower trend projection on the BHCG block of business resulting from the use of the Humana PreferredSM Network (BHCG); second, the Humana Preferred network provides approximately a 14-18 percent premium savings compared to Humana’s broader networks.
How is my group renewed through the BHCG?
The renewal rate is composed of three factors – trend, health status and demographic/plan adjustments. As mentioned previously, trend is tracked separately for BHCG groups. In order to determine the health status adjustment, Humana utilizes a tool called ImpactPro, which analyzes the current medical and pharmacy claims for a group. From that information, Humana is able to project the future claims risk for the following plan year. Demographic adjustments result from changes in average age, gender, coverage type and the number of employees enrolled in the plan.
BHCG’s Strategies
How do you influence the quality of health care services?
Humana, our administrative partner, works with Humana Preferred (BHCG) providers to measure and report compliance with best medical practices.
The BHCG also encourages providers to join the Wisconsin Collaborative for Health Care Quality – a group of health care provider organizations that work together to improve the quality and cost-effectiveness of health care in Wisconsin.
How do you hold providers accountable for helping to control health care costs?
In addition to being held accountable for quality of care delivered and medical best practices compliance, Humana Preferred providers must submit “best-offer” bids and support prospective pricing. They must also agree to participate in the BHCG action plan process by developing an annual plan focused on cost reduction through efficiency and quality of care improvements. Furthermore, providers must demonstrate support for information transparency.
What are you doing to expand access to consumer health care information?
We believe information transparency is an important part of a market driven health care delivery system. BHCG member company representatives participate on the Consumer Transparency Advisory Group, working with Humana to develop health care cost and quality information, which is made available to consumers on the Humana web site.
Through Humana Preferred, members have access to a custom Website with easy to use tools that compare both the cost and quality of health care providers. The Website offers cost estimates for entire episodes of care based on contracted rates, including information for 50 inpatient procedures, 31 outpatient procedures and 36 physician office visit types.
BHCG members also have access to “A Buyer’s Guide to Health Care,” our series of user-friendly online education modules designed to help people understand the health care system so they can make wiser choices.
We are supportive of the Wisconsin Health Information Organization (WHIO) – a partnership of health insurers, hospitals, doctors and employers who are committed to developing a centralized health care database to be used in quality improvement, provider performance measurement and public reporting. Our administrative partner, Humana, participates in the partnership and is contributing to the WHIO data set. Ultimately, WHIO’s activities will result in Humana having access to a robust data set that will allow for improved analyses of provider efficiency and compliance with evidence-based medicine.
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