Retiree Medical & Prescription Drug Benefits

HORIZON Health Ventures, LLC provides group retiree medical and prescription drug benefits exclusively through Benistar Admin Services, Inc.

Benistar is a nationwide leader in the design, installation and administration of post-65 retiree benefits including both fully insured and self funded Employer Group Waiver Plans (EGWP). Together with HORIZON Health Ventures, they work with brokers and consultants to provide retiree medical and prescription drug solutions for organizations nationwide.

Benistar deploys its resources in technology, administration and vendor management to provide single-source, full-service benefit programs that serve all of our clients’ needs.

As your retiree benefits partner Benistar will:

  • Provide retiree administrative services that meet or exceed the needs of retirees and plan sponsors
  • Maximize accuracy within a complex, dynamic environment
  • Minimize administrative requirements of maintaining retiree plans
  • Actively manage the rising cost of retiree benefits coverage

For over 25 years, Benistar has provided Employers, ERISA Plans, Taft-Harley Trusts, Affinity Groups and Municipalities with best-in-class employee benefits solutions. They are an industry leader in delivering innovative risk products and services for retiree, contributory and voluntary benefits programs.

Benistar's clients rely on them for the most efficient design, installation, communication and administration of benefits and insurance-related solutions.

Their consulting, administration, benefits outsourcing and financial services are provided by a highly trained staff of over 120 professionals dedicated to meeting the unique needs of their clients.

The Benistar Retiree Customer Service Center takes pride in helping clients solve problems. Because Benistar is focused solely on retiree medical and prescription drug programs, they have the expertise to answer questions and resolve issues related to the Medicare environment.

Currently, Benistar serves the needs of more than 700 plan sponsors throughout the U.S. and administers more than $100 million in annual premiums.

RDS Reopening

As part of the HORIZON suite of Retiree Medical and Pharmacy services, we also provide our clients who have filed or continue to file for the Retiree Drug Subsidy (RDS) with RDS Reopening Services. RDS Reopening is a process that allows Plan Sponsors to go back and “reopen” past reconciled plan years to see if they captured all eligible members and eligible prescription drugs that qualify for Retiree Drug Subsidy under the CMS RDS Program.

As with tax returns, errors can be made. CMS recognizes that Plan Sponsors may not have the systems and processes in place to accurately identify membership and eligible prescription drug claims. Reopening reconciled plan years gives Plan Sponsors a second chance to capture the entire subsidy that they are owed.

RDS Reopening is for plan sponsors who have filed for the RDS subsidy within the last four years on behalf of 200+ retirees. Average recovery for plan sponsors historically has been between 10%-12% of the subsidy already received over the allowed four year look-back period.

 

 

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Success Stories
Association Employer – New Jersey – HORIZON Solution: Employer Group Waiver Plan (EGWP)

Number of Retirees: 239
This Association had been managing their retiree pharmacy program and filing for the Retiree Drug Subsidy (RDS) since 2006 through its insurance carrier. After evaluation of current drug spend and projected RDS for 2014, the plan decided to move to a fully insured Employer Group Waiver Program (EGWP). Based on current enrollment, no change in plan design or drug plan, the group saved $430,000 or $1,800 PMPY. This was hard dollar savings and did not infer savings from the elimination of attestation, administration or from the elimination of OPEB liabilities.

Success Stories
Government Association - Washington, DC- HORIZON Solution: Employer Group Waiver Plan (EGWP)

Number of Retirees: 108
This Association had been managing their retiree pharmacy program and filing for the Retiree Drug Subsidy (RDS) since 2006 through its Pharmacy Benefit Manager (PBM). During the course of the relationship, the PBM never introduced the Employer Group Waiver Program (EGWP) to either the Association or their insurance broker. In May 2013, HORIZON Health Ventures introduced the concept of EGWP to the broker who immediately addressed the capability with the client. Keeping all pharmacy benefits the same, HHV was able to save this plan $189,000 or 28% of drug trend for 2014.

Success Stories
Municipal Employer –Michigan – HORIZON Solution: Employer Group Waiver Plan (EGWP)

Number of Retirees: 1,200
Managed for many years by the same carrier, this municipality moved their group retiree pharmacy program to HORIZON Health Ventures and its proposed Employer Group Waiver Program (EGWP) for a 13% savings to the plan. In addition, the group did so while improving their plan design on generic drugs. At the direction of HORIZON Health Ventures, the EGWP provider lowered copayments on generic products both at retail and mail thus resulting in greater steerage to lower cost products and thus a lower premium. In addition, based on this client’s plan year, (along with the new plan design adopted), the client was able to secure a rate cap for 2015 fixing their costs at a maximum liability until January 1, 2016.

Success Stories
Union – New Jersey – HORIZON Solution: RDS Reopening

Retirees Covered: 1,032
Reopening subsidy = $1,518,000
Additional subsidy = $280,000
18% additional subsidy recovered upon Reopening

Upon hiring HHV and RDS Reopening Services requested an audit of past Retiree Drug Subsidy filings from CMS. The request was approved and based on missed eligibility and inaccurate reconciliation of subsidy eligible claims, this client successfully Reopened their RDS filings from 2009-2012 recovering over $90,000 in additional subsidy. 

Success Stories
Municipality – New Jersey – HORIZON Solution: Pharmacy Benefit Management

Total Lives Covered – 2,900
Annual Drug Spend - $4,400,000
Issue – Adverse drug mix in the Proton Pump Inhibitor (PPI’s) category resulting in $297,000 in unnecessary drug spend.

Resolution – Plan design modification mandating PPI’s be purchased Over-the-Counter (OTC) along with full subsidy of a $0 copayment to the member.

Recommendation to eliminate member cost share for mandatory purchases of OTC PPI’s resulting in $177,000 net savings to the plan. Significant savings to both plan and member realized through slight modification of design and no member disruption.

Success Stories
Corporate Employer – Pennsylvania – HORIZON Solution: Medical Bill Review

Total Lives Covered – 400
Number of bills reviewed - 5
Total Amount of Hospital Bills Reviewed - $1,135,914
Negotiated Amount Paid by Plan Sponsor - $446,874

After hiring HHV for Cost Containment Services (Medical Bill Review), five out-of-network hospital bills (different patients with different health conditions) were reviewed for appropriateness and necessity. Due to the identification egregious billing practices, undocumented charges and reasonableness audit, successful negotiation was realized reducing the amount paid by $690,000.

 

"For the next 20 years, about 10,000 baby boomers will turn 65 each day."