The cost of claims drives the cost of employer health plans. See a sample proposal on of a specialized, self-funded health plan that lowers claim costs and makes health care work for employees and employers.

1. It’s here. It’s time.
Re-Thinking the
Traditional Health Plan
with YOUR BUSINESS
in Mind
HLU Open-Platform Health Plan Proposal for
Company Name Here
Date Here
Prepared by:
Mark Gall
Health Plan Consultant
513.559.7502 direct
markgall@hluconsultants.com
hluconsultants.com

2. HLU CONSULTANTS | Reclaim Control of Your Health Plan2
It’s an open-platform health plan that
provides the highest quality benefits at
the lowest costs with better employee
health outcomes.
An exciting change for the better, this
efficient and cost-effective self-funded
plan allows employees and employers
to reclaim ownership of their
healthcare benefits and costs.
It provides data you can act on and
use to tailor your plan for the greatest
value . . . it’s structured around a long-
term strategy to continually control
plan design effectiveness and costs . . .
and, it simplifies administration and
compliance along the way.
For the employee, it’s empowering.
HLU’s Open-Platform Health Plan
provides employees with educational
resources to help them make informed
decisions to select the best available
healthcare plans and options for their
needs. The result . . . better employee
health and lower plan costs.
We offer a smarter approach.

3. 3hluconsultants.com | 513.559.7503 | info@hluconsultants.com
The Consultant vs. The Broker
Take your pick: A fully customized solution or one-size-
fits-all product?
Don’t be misled. When expressing your interest in open-platform,
your broker may quickly try to discredit the self-funded model
or promise a “canned” product to match. But how can this be
trustworthy advice when it comes from someone who doesn’t know
the ins and outs of self-funding or specialize in a proven approach
with cost savings at the core?
The reality:
HLU operates as an independent, objective consultant that isn’t
limited to one set solution, but instead, collaborates with a whole
network of benefits and partners.
No product can match our solution. A broker often sees the plan as
a routine transaction/renewal, whereas we see a long-term solution
that solves a specific problem.
Experts agree that out-of-control claim costs are the number one
reason for high-cost health plans. Has your broker attempted to
address this?
Education is first and foremost. You should know exactly how much
your plan is spending on claims, and over-spending shouldn’t be
accepted as the norm.
Tweaking traditional plan designs or switching insurance companies
can only take you so far. Cost savings are only achievable if you
tackle the root of the problem head-on.

4. HLU CONSULTANTS | Reclaim Control of Your Health Plan4
How can your
business possibly
keep up with such
unpredictable hikes?
Here’s the thing –
But things
can change . . .
Most companies have no idea how much
their health claims are costing them or that
the issue of excess, unnecessary charges
has become so incredibly routine.
All too often, claims get processed and
paid without a thorough review to catch
errors and inconsistencies.
Common issues like overcharging,
miscoding and duplicate charges are
slipping through the cracks, resulting in
ridiculously high payments that are
eating away at your bottom line.

5. 5hluconsultants.com | 513.559.7503 | info@hluconsultants.com
It’s simple. This is a smarter way to manage health benefits …
one that works AND saves you money now and for the long-term.
HLU Open-Platform Health Plan puts YOU back in control through:
Meaningful data with the ability to analyze, model and forecast … this
significantly reduces the costs of administration, insurance and claims,
and allows you to adapt your plan whenever and however needed
Better care and improved outcomes because employees are more
engaged in their care … this leads to more effective disease management
and reduces excess office visits, lab tests, hospital admissions, etc.
Thorough claims review to identify overcharges and billing errors and
address them before claims are processed and paid
Best-in-class partnerships without being limited to a minimal number
of vendors
A “pay for what you use” approach to care with a plan built from the
most appropriate modules
Pricing transparency for medical services is achieved by giving
employees the resources they need to make the best choices and avoid
overpaying for provider services
Employee onboarding with 360-degree reporting and billing that’s
seamless and integrated
FMLA and COBRA compliance that’s hands-free and full-service
ACA compliance and employee notifications for your added convenience
1095-C or 1094-C tracking and reporting
Why HLU Open-Platform
Health Plan?

6. HLU CONSULTANTS | Reclaim Control of Your Health Plan6
Why is HLU for You?
Benefits Done Better
• We are fully independent consultants with each employer’s
best interests in mind
• We have 55 years of experience in the industry, backed by a
team of professionals who truly understand what works in a
plan and what doesn’t
• We are a focused and efficient company with national reach
that takes an objective approach to finding the best vendors
• You’ll work in partnership with the same account representative
who is focused on the full relationship, from sales to
implementation and strategy
• You’ll receive one-on-one customer service with a high-touch,
hands-on approach
• You’ll never have to worry about brand-name fees, incentives
or sales driven by commission coming into play

7. 7hluconsultants.com | 513.559.7503 | info@hluconsultants.com
Health Plan Basics
Typical Health Plan Costs Breakdown
The Claims Process
Claims
70%
Admin.
10%Insurance
20%
Employee Health
Plan ID Card
Health Care
Recieved
Health Care
Provider is Paid
EOB
Employee Receives
Explanation of Benefits
Claim is
Processed
National
Benefit
Administrator
with Advanced Claim
Processing and
One-on-One
Customer Service
Insurance Company
Closed Platform
Claim Process
No transparency, control or analysis
HLU Open-Platform
Claim Process
Options
Transparency
Control
Analysis
Stop-Loss
Insurance
to Protect Against
Large Claims and
Provide Guarantees
The Employee Routine is Unchanged
What Happens During the Claims Process
Invisible to Employee
Large Claim
Review
Itemized Claim
Review vs.
Summary or RBP
HR Services,
ACA Compliance
and Payroll
PPO Enhancement
The Nerve Center:
Controlled by the
Summary Plan Description
(SPD)
Disease
Management
and Wellness

8. HLU CONSULTANTS | Reclaim Control of Your Health Plan8
HLU Puts Plan Control and Cost
Savings Back in your Hands
Control of Health Plan Employer Insurance company Insurance company
Provider Network Access
Data Analysis & Forecasting
Large Claim Case
Management Analysis
PPO Enhancement:
Utilize Independent, Best-In-Class
Vendors to Reduce Claim Costs
Pricing Transparency for
Employee Medical Services
Customizable Summary
Plan Description (SPD)
Claim Review Procedure
Compliance & Employee
Onboarding
HLU Open-Platform Health Plan
with Healthcare Intelligence
Hybrid Plan Platform
ASO, Insurance Company, Self-Funded,
Level-Funded, Balance Funded Plans
Closed Platform
Humana, Anthem, UHC, MMOH,
Aetna, etc.
Traditional PPO Networks, National Access
and Customizable Networks
Typically 1 or 2 PPO options
(One size fits all)
Typically 1 or 2 PPO options
(One size fits all)
YES - actionable data Basic claims and expense overview only
Data is not actionable
No data provided
YES - actionable data No No
YES No No
YES No or limited No or limited
No or limited
YES Yes - with limitations No
Claims are itemized and reviewed for
overcharges and billing errors
Full Service, Hands-Free Suite: FMLA, COBRA,
5500, ERISA, ACA, FTE Record-Keeper and filings
Claims are passed through and paid
by a summarized invoice
Limited
Usually reference materials only
Claims are passed through and paid
by a summarized invoice

9. 9hluconsultants.com | 513.559.7503 | info@hluconsultants.com
Intelligent Claim Review and
PPO Enhancement
Do you think your PPO discount alone is enough to tackle the high prices of health care? It isn’t.
Because such enormous pricing variations exist for the same services among hospital systems
throughout the U.S., the integrity and effectiveness of PPO discounts are quickly diminished.
Fortunately, HLU Consultants has a solution – Fair Pricing Review and PPO Enhancement
programs – to level the playing field when health plans pay medical claims. Without an
intervention like this to keep an eye on prices, though, costs keep increasing.
HLU’s Open-Platform Health Plan enhances the best PPO discounts from CIGNA, UHC, MMOH,
AETNA, HealthSpan and others by comparing PPO claims to a National Fair Pricing Database.
We don’t stop there, large claims are physician reviewed for clinical accuracy, something that
will never happen with a Traditional Closed Platform Health Plan.
Bottom line, we’ll make sure you pay the lowest cost for your claims without disrupting
your employee or your business.
1. PPO Discount Model
• Applies a PPO negotiated discount to the
retail “master list” price
• Claim is processed with no clinical or fair
pricing review
• Has your insurance plan or broker ever given
you a savings report on a large claim?
2. HLU PPO Enhancement
• Claim is processed through the most
competitive PPO and claim is discounted
• Extra step: Claim is then compared to national
fair pricing benchmarks. Large claims are itemized
and physician reviewed for clinical accuracy
• 98% of adjusted claims are accepted by
the Provider
• The employee or the health plan is never
responsible for hidden charges or disputed
claim adjustments
3. Referenced Based Pricing, aka Tru Cost
• No PPO is used. Claim is processed with no
clinical or fair pricing review
• Claims are processed and paid at a % of Medicare
• Disruptive to employees. Employee is
responsible for balance bills
• Providers may not accept reference based
pricing plans
• Google: “Cincinnati, New Insurance Plan Pits
Employers Against Hospitals.”
PPO Example
Claim $100,000
PPO Discount (45%) - $45,000
Health Plan Responsibility $55,000
HLU Example
Claim $100,000
PPO Discount (45%) - $45,000
$55,000
Intelligent Claim Review
Fair Pricing Discount - $20,350
Clinical Review Discount - $6,600
Health Plan Responsibility $28,050
Tru Cost Example
Claim $100,000
No PPO Discount - $0
No Intelligent Claim Review - $0
Medicare Reimbursement
Rate x 150% $33,750
Health Plan Responsibility $33,750
Employee may use a Patient Advocate to settle
the balance.

10. HLU CONSULTANTS | Reclaim Control of Your Health Plan10
PPO Enhancement
HLU Intelligent Claim Review
Large Claim Review Process
Universal Bill (UB) sent by hospital to HLU
National TPA
TPA Adjudicates UB
TPA Applies PPO Discount to UB
HLU Intelligent Claim Review Requests
Itemized Bill (IB)
HLU Intelligent Claim Review Digitizes IB
HLU Intelligent Claim Review MD Line
Item Review
HLU Intelligent Claim Review Calculates
Savings & Summary Report
Bill Paid
Employee is guaranteed to never be balance
billed for PPO Enhancement discounts
98% of adjusted claims are accepted with no
push-back from medical provider
Health plan is charged 25% of savings over
and above the PPO discounted claims for an
average savings of 25%
Claim review fees are accepted and covered
by stop-loss insurance
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REVIEW EXAMPLES
CLINICAL
Unnecessary Test
ICU Bed Not Needed
INTEGRAL
Un-Bundled
Re-Bundled
REASONABLE & CUSTOMARY
$1000 Toothbrush
ERRORS
Duplicate Charges
NEVER EVENTS
Amputate the Wrong Leg

11. 11hluconsultants.com | 513.559.7503 | info@hluconsultants.com
Notes & Questions

12. Learn more about HLU Consultants:
It’s here. It’s time.
Are You Ready for a
Smarter Health Plan that
has YOUR BUSINESS
in Mind?
Contact:
Mark Gall
Health Plan Consultant
513.559.7502 direct
markgall@hluconsultants.com
hluconsultants.com