In everything we do, we believe in challenging the status quo

We believe that business owners need to have control over all aspects of their business, including healthcare

Key Features of Simplicity Benefits Health Plans

  • Competitive Rates
  • Office Visit Copays
  • 4-Tier Prescription Benefit Plan
  • Wellness Program
  • Telephone Access to Physicians 24/7
  • Online Health Information Resources
  • Medical Bill Negotiation
  • Fraud and Waste Control
  • 12/21 contract basis
  • Internal pooling point maximizing the potential for employer refunds
  • All industries eligible with the exception law firms and MEWAs
  • Group size: 10-200 lives (Claims data is preferred for groups over 100 lives)
  • Unused claim fund is refunded entirely to the employer at the end of the plan year
  • Stop Loss insurance offers full protection from larger claims. Employer will never have to pay more than the maximum monthly cost.
  • The predictability of a level monthly cost—there are no extra charges if there are high claims.
  • ERISA plan that is exempt from some of the Affordable Care Act regulations—particularly those parts that may cause fully insured premiums to climb substantially in 2015.
  • Maximum annual claims costs are predetermined and the employer pays 1/12 of this cost each month for the 12 months of the plan year. After this amount, there are no other charges from the claim fund.
  • The employer will receive monthly reports on all claims paid during the month and the plan year-to-date. Each quarter, they will receive a detailed report about claims (subject to federal and state privacy regulations). This reporting provides the information necessary to fully track the claim fund and to understand where the claim fund dollars are spent such as physician’s office visits, prescription drugs, outpatient services and hospitalizations. With this information, the plan can be designed to contain costs and target problem areas.
  • The plan year runs for 12 months from the effective date. Claims incurred during the plan year will be paid through a 9-month run-out period and any balance remaining in the claims fund is returned to the employer. Terminal Liability coverage is built into the plan by providing the 9-month run-out period. (Funds returned to the employer may be used in a limited manner. Please contact your broker or tax consultant for additional information).

See What Our Claims Fund Has To Offer Your Business

Prescription Benefit Manager

Claims Processing

Lifestyle & Care Management

Claims Fund

Fraud & Waste Containment

Reinsurance Companies

Provider Networks

Simplicity Benefits works closely with our customers to design plans that meet the needs and aspirations of business owners for years to come. We help turn an annual aggravation into a solid financial strategy that benefits employers and employees alike.

Prescription Benefit Manager

ProCare-Rx
  • Simple, transaction-only pricing, approximately $4.25 per script
  • No price differentials
  • Founded and managed by pharmacists
  • Data-Driven
  • CVS Caremark, McKesson and Express Scripts are all in the Fortune 50

Prescription Benefit Manager

ProCare-Rx
  • Simple, transaction-only pricing, approximately $4.25 per script
  • No price differentials
  • Founded and managed by pharmacists
  • Data-Driven
  • CVS Caremark, McKesson and Express Scripts are all in the Fortune 50
  • Provides TPA services for self-funded plans in all 50 States
  • Adjudicates all claims via Automation and Eyeballs
  • Very involved in Plan Design
  • Data-Driven Claims Utilization is closely scrutinized
  • Every account has their own claims fund – No commingling of client funds
  • Monthly Claims Report and Balance Sheet
  • Customers keep 100% of claims fund surplus
  • All ACA-related compliance, noti! cation requirements and federal filings

Claims Processing

Covenant Services Group

Claims Processing

Covenant Services Group
  • Provides TPA services for self-funded plans in all 50 States
  • Adjudicates all claims via Automation and Eyeballs
  • Very involved in Plan Design
  • Data-Driven Claims Utilization is closely scrutinized
  • Every account has their own claims fund – No commingling of client funds
  • Monthly Claims Report and Balance Sheet
  • Customers keep 100% of claims fund surplus
  • All ACA-related compliance, noti! cation requirements and federal filings

Fraud & Waste Containment

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  • Fraud and waste account for 5-15 cents of every healthcare dollar spent
  • Detects waste and fraud BEFORE payments are authorized
  • Insures that employers and employees are paying the right price to the right providers for the right services

Fraud & Waste Containment

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  • Fraud and waste account for 5-15 cents of every healthcare dollar spent
  • Detects waste and fraud BEFORE payments are authorized
  • Insures that employers and employees are paying the right price to the right providers for the right services
  • PHCS/Multiplan
  • Largest Domestic Provider
  • Competitive pricing
  • Flexible Network Design

Provider Networks

PHCS Multiplan

Provider Networks

PHCS Multiplan
  • PHCS/Multiplan
  • Largest Domestic Provider
  • Competitive pricing
  • Flexible Network Design

Reinsurance Companies

Gerber Life Insurance Company
  • AmTrust Financial
  • Companion Life
  • Gerber Life
  • Houston Casualty Company
  • Nationwide Insurance
  • SunLife Financial
  • Trustmark/Starmark
  • WR Berkley

Reinsurance Companies

Gerber Life Insurance Company
  • AmTrust Financial
  • Companion Life
  • Gerber Life
  • Houston Casualty Company
  • Nationwide Insurance
  • SunLife Financial
  • Trustmark/Starmark
  • WR Berkley
  • Integrated online experience for employees
  • Enterprise Solution for SMB Market
  • Staffed by health coaches, RNs, therapists, nutritionists, etc.

Lifestyle & Care Management

Bravo Wellness

Lifestyle & Care Management

Bravo Wellness
  • Integrated online experience for employees
  • Enterprise Solution for SMB Market
  • Staffed by health coaches, RNs, therapists, nutritionists, etc.

About Simplicity Benefits

Simplicity Benefits, LLC is an Atlanta-based provider of partially self funded healthcare solutions for small to medium sized businesses. Through our affiliation with Third Party Administration, Stop-loss Insurance providers, Extensive Provider Networks, Pharmacy Benefits Administration and Wellness programs – we offer flexible benefit plans designed to do what health plans should do – keep employees healthy and keep health care costs predictable and low for everyone.

Our Partners

Simplicity Benefits is proud to partner with these companies to provide the best healthcare solutions available.

Voluntary Benefits
FLEX HR
Covenant Services Group
Group Benefit Services
Milton Park Partners

Contact Simplicity Benefits