Innovative health plan design and administration

With more than 30 years’ experience working with Funds and Trusts, we can design, implement, and administer health and welfare plans that maximize member benefits and minimize your costs. We also streamline the process of member eligibility and enrollment to quickly onboard members and manage ongoing eligibility.

MagnaCare covers all your health and welfare plan needs:

  • Flexible claims management
  • Integrated ancillary benefits
  • Plan document management
  • Customized ID cards
  • COBRA notification and processing
  • HIPAA compliance

Customized benefit design

Since no two clients are alike, we will work with you to design and customize health and welfare plans that suit your population and budget. You can determine copay amounts, deductibles, covered services, services requiring prior authorization, coverage levels for out-of-network services, and more.

Whichever plan you choose – PPO plans, consumer-driven health plans (CDHP) such as HRAs and HSAs, or other plan types – you’ll be supported by an account management team that is committed to the success of your health plans. We offer extensive provider networks for convenient member access, in your region or nationwide.

Flexible administration and reimbursement models

Save with lower administrative fees on our self funded health plan, where you pay only for member claims and not a monthly premium that goes up every year. You gain full transparency into your claims data and exemption from state and premium taxes.

We work with every client to determine optimum funding. Thanks to our broad experience as a health plan administrator and our extensive, national provider networks, we can administer custom benefits that meet the specific needs of your group. These include:

Tiered benefits

Through plan design and care coordination services, we can guide your members to seek care from your preferred providers. Our robust technology platform support flexible claims management, including tiering.

Custom reimbursement administration

Our claims management system supports an array of pricing models, including reference based pricing, to help you contain costs. You can choose to set spending limits on high-cost procedures and negotiate value-based pricing with hospitals and outpatient facilities based on Medicare rates or a custom fee schedule.

Level-funded

Pay a fixed monthly amount, based on previous claims history. You’ll receive a refund if the annual claims experience is lower than the maximum liability.

Lower costs through effective medical management programs

Our in-house clinical team provides utilization management, case management, cost containment, and other medical management services to oversee the quality and cost of care. By layering medical management services over your existing provider network, we can:

  • Monitor the services your members receive to make sure they are medically necessary
  • Review claim activity to identify repetitive and unnecessary treatments and procedures
  • Guide patients to lower cost facilities for high-cost testing, imaging, and other services

Unburden your COBRA administration

COBRA requirements are so complicated, it takes an expert to manage your cases effectively and ensure compliance. We’ll manage eligibility, record, deposit, reconcile COBRA and retiree contributions, and handle all communications with your COBRA members.

Simplify health plan management with advanced technology

Our Create® Technology platform makes it easy for you to manage your plan and engage your members. Its intuitive Administrator dashboard lets you:

Communicate effectively with members, replacing costly mailings

View and manage eligibility and enrollment

Review claims data and track medical spend

Monitor employer hour uploads and premium payments

Receive actionable, real-time reporting on key demographic, utilization, and trend metrics to help control costs

Friendly mobile app

The mobile app gives members round-the-clock access to the same medical and health plan information that they can view on the Member portal:

  • Find a provider
  • Display and email ID cards
  • View claims and EOBs
  • Access ancillary provider information, such as dental, pharmacy, and vision
  • Check covered services
  • Live chat, email, and callback for customer service
  • Instantly access deductibles, out-of-pocket maximums, and balances for medical, dental, vision, life insurance, and so on

Give your members a first-class customer service experience

Provide superior customer service using our locally based, on-shore, multilingual team of customer service experts. With a 99% first call resolution rate and less than 30 seconds average speed to answer, we have never missed a performance guarantee – ever.

Members can contact our concierge team by phone or email, or online using click-to-call, click-to-chat, or request a callback.

Our concierge services give members everything they need to feel in control of their health care:

  • Help members navigate provider options and explain any potential out-of-pocket costs
  • Schedule members’ appointments and follow-up visits, and confirm benefits and eligibility with the provider
  • Respond to member questions about medical and other benefits
  • Direct members to additional vendors, with warm transfer to other vendors’ customer service

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How can we help?

Feel free to ask a question or simply leave a comment.