Is 90 Degree Benefits an Insurance Company? Unveiling the Truth

The answer, unequivocally, is no. 90 Degree Benefits is not an insurance company. Instead, they operate as a third-party administrator (TPA) and a benefits management company. They provide a range of services to self-funded employers, helping them manage their employee health benefit plans without directly assuming the financial risk of insuring those plans.

Understanding the Role of 90 Degree Benefits

Instead of being an insurance company, 90 Degree Benefits acts as a crucial intermediary. They handle the administrative tasks and processes associated with self-funded health plans. This includes claims processing, member enrollment, network management, and often, providing access to tools and technologies to help employers and employees navigate the complex world of healthcare. Think of them as the engine that keeps the self-funded benefits machine running smoothly.

What is a Third-Party Administrator (TPA)?

A TPA is an organization that provides operational services, such as claims processing and benefits administration, under contract to another party. In the context of health benefits, that “other party” is typically an employer that has chosen to self-fund their health plan. This means the employer, rather than an insurance company, bears the financial risk of providing healthcare coverage to its employees. The TPA manages the day-to-day operations, allowing the employer to focus on their core business. 90 Degree Benefits excels in this role, offering customized solutions to meet the unique needs of each employer they partner with.

Why Choose Self-Funding?

Self-funding offers employers greater control over their healthcare spending. By bypassing traditional insurance models, they can tailor their benefit plans to the specific needs of their workforce. This often leads to cost savings in the long run, particularly for companies with a healthy employee population. However, self-funding also comes with risks. A TPA like 90 Degree Benefits helps mitigate those risks by providing expert guidance and efficient administration.

Frequently Asked Questions (FAQs) About 90 Degree Benefits

Here are 12 frequently asked questions to further clarify the role and function of 90 Degree Benefits:

1. What specific services does 90 Degree Benefits provide?

90 Degree Benefits offers a comprehensive suite of services, including:

• Claims Administration: Processing and paying medical, dental, and vision claims accurately and efficiently.
• Benefit Plan Design: Assisting employers in designing benefit plans that meet their employees’ needs and budget.
• Network Management: Negotiating contracts with healthcare providers to obtain competitive rates and build strong networks.
• Member Services: Providing customer support to employees, answering questions about their benefits and claims.
• Data Analytics & Reporting: Offering detailed reports and data analysis to help employers understand their healthcare spending and identify areas for improvement.
• Compliance Support: Ensuring benefit plans comply with all applicable federal and state regulations.
• Wellness Programs: Implementing and managing wellness programs to promote employee health and reduce healthcare costs.
• Pharmacy Benefit Management (PBM): Working with PBMs to manage prescription drug benefits effectively.

2. How does 90 Degree Benefits differ from a traditional insurance company?

The core difference lies in risk assumption. Insurance companies assume the financial risk of healthcare claims. They collect premiums and pay claims out of those premiums. 90 Degree Benefits, as a TPA, does not assume this risk. The employer retains the risk and funds the plan directly. 90 Degree Benefits simply manages the administrative aspects of the plan on behalf of the employer.

3. What are the benefits of using a TPA like 90 Degree Benefits?

The benefits are numerous:

• Cost Control: Greater control over healthcare spending through customized plan design and data-driven insights.
• Flexibility: The ability to tailor benefit plans to meet the specific needs of the workforce.
• Transparency: Clear visibility into claims data and administrative fees.
• Improved Employee Satisfaction: Enhanced member services and personalized support.
• Compliance Expertise: Ensuring compliance with complex healthcare regulations.

4. Is 90 Degree Benefits responsible for paying claims?

Yes, 90 Degree Benefits is responsible for processing and paying claims, but the funds used to pay those claims come directly from the employer’s self-funded account, or through stop-loss insurance reimbursement. They act as the payor, but not the insurer.

5. What is “stop-loss” insurance and how does it relate to 90 Degree Benefits?

Stop-loss insurance is a crucial component of self-funded health plans. It protects employers from catastrophic healthcare claims that could bankrupt their company. It comes in two main forms:

• Individual Stop-Loss: Reimburses the employer for claims exceeding a specific dollar amount per individual employee.
• Aggregate Stop-Loss: Reimburses the employer for total claims exceeding a specific dollar amount for the entire group of employees.

90 Degree Benefits often helps employers procure and manage their stop-loss insurance coverage, ensuring they are adequately protected against financial risk.

6. How does 90 Degree Benefits ensure the accuracy of claims processing?

90 Degree Benefits utilizes advanced technology and rigorous processes to ensure claims are processed accurately and efficiently. This includes:

• Automated claims adjudication systems: Which automatically process claims based on pre-defined rules and plan parameters.
• Regular audits and quality control checks: To identify and correct any errors in the claims processing system.
• Experienced claims examiners: Who review complex or unusual claims to ensure they are paid correctly.

7. What type of employers typically use 90 Degree Benefits’ services?

90 Degree Benefits primarily serves mid-sized to large employers who are looking for greater control over their healthcare costs and benefit plan design. These employers typically have a stable employee population and a good understanding of the benefits of self-funding.

8. How can an employer determine if self-funding with 90 Degree Benefits is right for them?

Several factors should be considered:

• Employee population size and demographics: Self-funding is generally more suitable for larger, healthier groups.
• Risk tolerance: Employers need to be comfortable with the financial risk of self-funding, even with stop-loss insurance.
• Administrative capabilities: Employers need to have the resources to manage the administrative aspects of a self-funded plan, or partner with a TPA like 90 Degree Benefits.
• Financial stability: Employers need to have the financial resources to cover claims and administrative costs.

A thorough cost-benefit analysis and consultation with a benefits consultant can help employers determine if self-funding is the right choice for them.

9. What technology does 90 Degree Benefits utilize?

90 Degree Benefits leverages various technologies to streamline benefits administration, improve member experience, and provide valuable data insights. This may include:

• Online portals for employers and employees: To access plan information, submit claims, and manage benefits.
• Mobile apps: For easy access to benefits information on the go.
• Data analytics dashboards: To track healthcare spending and identify trends.
• Automated claims processing systems: To speed up claims adjudication and reduce errors.

10. How does 90 Degree Benefits handle member privacy and data security?

90 Degree Benefits takes member privacy and data security very seriously. They implement robust security measures to protect sensitive health information, including:

• Compliance with HIPAA regulations: Ensuring all data is handled in accordance with federal privacy laws.
• Data encryption: Protecting data both in transit and at rest.
• Access controls: Limiting access to sensitive data to authorized personnel only.
• Regular security audits and penetration testing: To identify and address any potential vulnerabilities.

11. Does 90 Degree Benefits offer wellness programs?

Yes, 90 Degree Benefits often provides access to or manages wellness programs designed to promote employee health and prevent chronic diseases. These programs can include:

• Health risk assessments: To identify potential health risks.
• Wellness coaching: To help employees make healthy lifestyle changes.
• Onsite health screenings: To detect health problems early.
• Incentive programs: To reward employees for participating in wellness activities.

12. How can I learn more about 90 Degree Benefits and their services?

The best way to learn more is to visit their official website or contact them directly for a consultation. They can provide detailed information about their services and answer any specific questions you may have.

In conclusion, remember that 90 Degree Benefits is not an insurance company, but rather a valuable partner for employers seeking to effectively manage their self-funded health benefit plans. Their expertise in claims administration, network management, and compliance support makes them a vital resource for companies looking to control costs and provide high-quality healthcare coverage to their employees.