Plan Design

A crucial tool to controlling your health care costs is to create benefit plans that build in cost management features. Kanawha HealthCare Solutions (KHS), a Humana company, can work with you to create a benefit plan that is right for you and your employees.

The use of a Preferred Provider Networks to manage health care costs and utilization is a basic and very common feature. Kanawha can assist you in creating PPO, POS or EPO plans, depending upon the level of care management you desire.

In order to provide your benefit plan with the right fit, Kanawha maintains relationships with more than 30 local, state, regional and national Provider Networks, giving your employees the coverage they need with some of the best provider discounts available.

Other Plan Designs

Kanawha will work with each employer group to determine the best plan design for their needs. Kanawha can create indemnity, managed indemnity or any combination of plan design in order for our employer groups to take advantage of cost management design, while suiting your needs.

Kanawha led the industry by launching our "consumer-driven" product in July 2002. This product empowers your employees to take more ownership in being responsible stewards of their health care dollars.

By providing an incentive, in the form of a personal health account that can be rolled over from one year to the next, employers reward employees for managing their health care dollars.

This is designed to change, or modify, behavior over time, weaning them off of the $10 copay made so popular by the managed care model.

Flexibility is one of the primary advantages to choosing to be self-funded. Kanawha can assist you in creating the proper plan design for your employees and your budget.

Benefit Design

There are many options available for self-funded groups in the design of your benefit structure. As a self-funded group, you can choose the benefits and coverage levels your employees need and desire, while ensuring the right level of cost and utilization management to protect your bottom line.

Benefit Plan Attributes:

These are just a few of the options you have in choosing the benefit mix that best fits your employees.

When designing your benefit plan, it is important to understand the dynamics of how benefit structure can drive utilization. In fact, over utilization is commonly the reason for greater than expected health care costs.

KHS Administrative Services

KHS provides your optimal combination of benefit flexibility and cost management technology through the following services:

Optional Administrative Services

• Traditional Plan and High Deductible Plan/Consumer Driven Health Plan (CDHP) administration, Health Reimbursement Account (HRA), Health Spending Account (HSA), Flexible Spending Account (FSA).
• Dental administration
• COBRA and HIPPA administration
• STD administration
• Bulk pay/no pay option for hospital groups
• Run-in/run-out administration
• Multiple TPA-negotiated PBM contracts available
• Health management services, pre-certification, concurrent review, discharge planning
• Risk identification through automated ICD-9/drug type review, health risk appraisals, and predictive modeling
• Case management
• High cost / injectable drug management program
• Comprehensive “Healthy Solutions” and other Health Management Programs

Risk Management Services

• Stop loss underwriting department
• Dedicated staff for stop loss claims filing
• Subrogation services

Provider Network Management Services

• Access to multiple rental networks and Kanawha’s proprietary network
• Dedicated staff to provide contracting/management services for custom access solutions