The Importance Of Exploring Self-Funding Solutions And Determining If It Is The Right Fit


Loomis Specialty Programs have been created to decrease claim costs, increase member education, improve productivity and much more by providing:

  • Proper Stop Loss Contracts for Protection
  • Referenced Based Pricing Solutions
  • Claims Subrogation Solutions
  • Specialty Care Drug Management Programs
  • Online Rx tools to compare drug costs
  • Specific Diagnostic Test Networks – Xrays, MRIs, Scans and more
  • Telemedicine tools to decrease over utilization of Emergency Rooms
  • Member tools to assist in identifying low cost / high quality providers
  • Online tools that assist members with health care delivery
  • Organ Transplant Coverage
  • Dialysis and Cancer Risk programs
  • Minimum Essential Coverage (MEC) programs
  • Captive solutions for employers moving from Fully Insured benefits
  • MedEncentive Program – awarding members for following physician protocols
  • Self funded plans that are Fully Funded/Level Funded Benefit Plans
  • Stop Loss solutions for all programs and benefit plans


Loomis Claim Management / Cost Controls: 

PPO Savings and network discounts are only a piece of total plan savings. Loomis claim system edits and claim controls provide our clients with “Administrative Savings” which can equal traditional PPO savings. Examples are:

  • Claim elimination (dual submissions, bundling of labs, multiple surgeries, and more)
  • Claim direction – through PPO guidance, dialysis and cancer programs, diagnostic care networks(Xrays/MRIs/scans), organ transplant providers – Loomis directs members to high quality low cost provider alternatives
  • Referenced Based Pricing Alternatives – using Medicare allowances for both in network and out of network providers.
  • Analytics that identify gaps in care, unnecessary care, predictive modeling and more. Allowing employers to modify benefit plans based on use.
  • Bill review programs – on a pre-pay basis
  • Subrogation tools protecting employer plan assets

**Based on these claim and cost controls, many of Loomis’ top Loss Carrier partners consider Loomis a preferred TPA – representing reduced premiums and claim attachment point. Providing further claim cost saving to our customers.  

Loomis Programs – Encouraging/Promoting Employee Engagement 

Even without high deductible plans, employers need for their plan members to better understand the health care delivery system. Plan members need tools, to access all aspects of care. Loomis provides such to all employers that make this process an easy one…

  • Member Portals – outlining claim payments, eligibility, provider look up, provider price tools, quality of care tools, prescription drug cost comparison tools, and more..
  • Patient advocacy tools
  • Pre-authorization lists made readily available – providing members with knowledge of care that must first be authorized.
  • Plan benefits, claim forms, etc…
  • Mobile Phone applications providing all member data in your fingertips