Aetna Aso Agreement

Aetna Aso Agreement

Only administrative services (ASOs) refer to an agreement that companies use when funding their staffing plan but hire an external provider to manage it. For example, an organization may instruct an insurance company to assess and process claims as part of its staff health plan, while maintaining responsibility for paying fees. An ASO agreement contrasts with a company that sources an external health insurance provider for its employees. ASO agreements are common in Canadian health plans. Plan specifications vary depending on a company`s agreements with insurance companies and external managers (TPAs). In the ASO agreements, the insurance company offers little or no insurance coverage, which contrasts with a fully insured plan sold to the employer. As the cost of health care continues to rise, companies are always looking for ways to control costs without harming the health of their employees. With these plans, your employees have higher deductibles. However, you can use a pre-funded expense account, for example. B a health savings account, to pay medical fees. You pay lower premiums for these plans. Therefore, an ASO plan is a kind of self-insured or self-financed plan.

The employer takes full responsibility for the claims made to the plan. For this reason, many employers who use ASO plans also establish aggregated stop policies in which the insurance company assumes responsibility for paying debts above a certain level; z.B. $10,000 per insured person against a premium. The results? A healthier end result. And a boost for your community. This is because healthy businesses help build healthy communities in which employees live and work. Cost control is not just about informing employees of the value of generic drugs and staying in the network. It is also about saving time and money for administrative work. However, employers would be responsible for any deficit if the receivables exceeded the expected amounts.

Catastrophic statements or sudden and unexpected events are of particular concern. Employers often invest in stop-loss insurance to provide an additional level of coverage in these cases. This serves only to illustrate. Premiums, receivables and dollar surpluses depend on the plan agreement. Self-funded plans may be more flexible than fully insured traditional plans.