edHEALTH offers brokers the opportunity to provide a cost-effective healthcare solution to their higher and secondary education clients. By recommending edHEALTH, you will bend your educational clients’ healthcare cost trend. Additionally, as a member school advisor, we’ll include you in Plan Design and other group meetings so that you are aware of issues that your client and others are discussing. These opportunities allow you to increase your visibility and knowledge while enhancing your strategic role.

Disruption to coverage, healthcare provider access, and plan design is minimal. Through our hands-on approach, our new members experience seamless transitions with little or no coverage or provider interruptions. edHEALTH has an active Plan Design Committee made up of representatives from each member institution and their advisors who work with the Third-Party Administrators (TPAs) to determine plan designs customized to meet the needs of edHEALTH members.

edHEALTH has a range of plan designs that are customized to meet the needs of edHEALTH members. Representatives from each member institution (typically benefits administrators) meet monthly to determine design options for the upcoming plan year. The Plan Design Committee’s collaboration with the Third-Party Administrators (TPAs) helps to ensure the optimal suite of choices. edHEALTH works with new member institutions and their advisor to create customized plan designs as needed.

Yes. edHEALTH customizes its medical and pharmacy programs to meet the needs of religious institutions.

edHEALTH is available throughout the United States.

edHEALTH has two regional and one national healthcare TPAs. We also use a prescription drug carve-out administrator.

Here are the tasks and deadlines for joining January 1; joining at another time of year impacts the deadlines but not the tasks:

• Submit letter of authorization and claims data by August 31
• Determine plan designs by August 31
• Review rates, make plan design adjustments, and determine choice of carrier by September 15
• General Counsel executes contractual agreements by October 1
• Fiscal Department provides financial and banking information by October 15
• Open Enrollment takes place October – early November
• Estimated healthcare and stop-loss insurance premiums due for January by December 15
• Adjusted final enrollment and stop-loss insurance premiums due for January by February 1

While we haven’t had any member-owners leave edHEALTH, a member-owner may elect to do so after an initial three-year commitment. There are no costs to leave.  Once a departing member’s financial obligations to edHEALTH are fully satisfied, all its insurance claims financed through the captive are fully settled and paid, and the required regulatory approval is received, all remaining capital and surplus attributable to a member are returned.

edHEALTH charges prospective members a nominal non-refundable working rate quote fee. This amount is applied to your capital contribution upon joining. The fee represents the actuarial cost to calculate the working rate including a breakdown of all expected costs for the plan year.

edHEALTH’s purchasing power allows us to negotiate low Third-Party Administrator (TPA) fees. Each member selects its own TPA and plan design from our suite of healthcare options. We underwrite your institution’s rates based on your school’s plan design, claims experience, census data, and the self-insured retention rate you’ve selected.

No. There are no fees to join edHEALTH. When a school joins edHEALTH, it must pay an initial surplus capital contribution to edHEALTH’s captive. The deposit is a member capital asset. 

Member-owners can access the following reports on the edHEALTH portal:

• High-cost claims report
• Quarterly actuarial report
• Prescription drug rebate information
• Important owner information
• Plan design minutes and presentations
• Member services guide

Member-owners and their advisors can access the following reports on the OptumRx RxTracks portal:

• Standard reports including utilization and claims detail
• Membership management including eligibility, history, and trend reports
• Product management including top drugs report
• Pharmacy management including top pharmacies report
• Prescriber management including top prescribers report
• Clinical management including controlled substance and multiple provider details
• On-demand reporting where you can generate customized reports