Resources for Employers
Employee Enrollment Form
Want to customize the enrollment form that your employees complete each year? This form allows you to enter your group’s unique plan information for a customized experience.
Customize Now
Solutions Information for Current Clients
Products
- Telemedicine – No matter the day, time or place, telemedicine is the gateway to providing members with accessible, qualified care whenever they need it.
- Wellness program – We partner with a leading digital health company, to develop wellness and disease management programming that promotes healthy habits and valuable member incentives. We can also partner with your preferred vendor to bring your wellness program to life.
- Utilization Management / Utilization Review (UM/UR) – An ongoing review of health care benefits can lead to cost savings and improved quality of services.
- Care management – Creating a holistic, integrated system of care for those with complex or chronic illness.
- Vision – Products available to use throughout the country.
- Dental – With a broad, national network, we give you easy dental coverage options for your employees.
- Prescription – Making sure members have access to affordable prescriptions.
- Stop loss – Offering peace of mind when you face the uncertainty of high claims.
You can craft solutions with a variety of vendors for the different components of your plan. Once your plan is implemented, we’ll provide you with in-depth reporting showing the trends of your employees’ benefits utilization. From there, we can adjust your benefits structure to match your desired trends. Equally important is our consolidated invoicing and stop loss options, to streamline operations and protect your organization from undue risk. From the initial meetings through general day-to-day account administration, we are with you at every step.
Funding
Types of Funding
Flexibility is choosing what works for you, not being handed someone else’s limited options. CareFirst Administrators wants Maryland, D.C. and Northern Virginia employers to have choices. Let’s meet and talk about what your organization needs, may be unsure about, or what’s worth some exploration. From there, we can craft the plan with the greatest ROI to your team.
Self-funding/Administrative Services Only (ASO)
If you want to be more engaged in the claims process and actively manage funds, self-funding may be the best fit. You pay us an administrative fee and our team processes claims and works with top health care providers to get quality services at competitive rates. The difference is that your organization funds all claims as they occur. The advantage is that unspent funds are kept within the company, avoiding the costs associated with fluctuating claims. For more protection, individual and aggregate stop loss insurance can be added to help protect you from unexpected costs.
Stop Loss and Cash Flow Protection
Minimizing risk is so important to our stakeholders, so we are committed to providing stop loss protection. In the event there is a stop loss claim, CareFirst Administrators will work with the stop loss carrier to pay that claim without impacting your funds – it’s that simple. The only constant in life is change, and sometimes the unpredictable happens. Our job is to make sure that when uncertain situations arise, you are protected.
Networks
Blue Distinction Centers (BDCs)
Because CareFirst Administrators is backed by Blue Cross Blue Shield, we have access to unique resources like Blue Distinction Centers (BDCs). These are health care providers and centers providing outstanding, affordable care in 10 different specialty medicine fields nationwide. Research shows that in terms of overall care, those treated at BDCs see better results, fewer complications, lower readmission rates and the best cost savings.1 CareFirst Administrators can help you find your BDCs so that employees have access to premier specialty health care.
Blue Select Network
Select networks are low cost and open-access. Members can choose from smaller groups of providers within the BlueCard network. With the expansive power of Blue, your employees will have the security of national coverage while you enjoy lower costs wherever your facilities are located.
Domestic Networks
Whether you’re a health system with your own “network within a network” or have an on-site employee health center, we can structure your employees’ benefits around a network that best meets your needs. With this option, you can encourage employees to take advantage of the facilities and infrastructure you’ve worked hard to put in place.
Tiered Networks
Tiered benefits give you the power to steer employees to select providers. You can design benefit levels in each tier for added cost savings. With tiered networks, you benefit from a large national network while allowing members to decide where to receive care. You can design tiers to meet specific goals like cost savings or maximize visits to on-site facilities (hospitals and health campuses) while maintaining quality and encouraging selection of top-tier providers.
Example of a Tiered Network’s Structure
(in-network)
includes a smaller network of providers that you’ve selected, reducing cost of care for you and decreasing member out of pocket expenses.
(in-network)
benefits allow members to select a provider from a broader network of contracted PPO providers, but at a higher out-of-pocket expense.
(out-of-network)
incurs the highest costs to the member and employer, generated by out-of-network care.
If you are interested in crafting tiered benefits and incentivizing employees to visit Tier 1 providers, CareFirst Administrators can help you design a custom solution unlike any other.
1 BCBSA data, BDC/BDC+ eligible facilities vs. relevant comparison group. Results based on most recent designation cycle for each specialty. Savings based on total episode cost.