Maxon FAQ

What kind of Company is Maxon?

Maxon is a Third Party Administrator that has been business since 1955.

What is a Third Party Administrator?

The term Third Party Administrator (TPA) refers to firms which provide comprehensive benefits administration and management services to sponsors of employee benefit plans. In essence TPA’s do all the things insurance companies do except underwrite risk.

What services does Maxon provide?

Maxon provides comprehensive consulting, plan design, plan management, administration, and claims administration services for all types of employee benefit plans, both insured and self-funded.

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What is a Self-Funded Health Plan?

A Self-Funded Health Plan is one in which the employer or other plan sponsor assumes the risk of providing its employees health benefits. This is contrasted with an insured plan which is one in which the employer or plan sponsor pays premium to an insurance company which assumes the risk of providing the necessary health benefits.

What are the advantages of a Self-Funded Plan?

There are distinct advantages that apply to all self-funded plans. Self-funded plans do not pay premium tax. Self-funded plans keep earnings on their claim reserves. Self-funded plans have access to the pharmaceutical plan rebates that are normally kept by their insurance companies. Self-funded plan sponsors do not pre-pay their claim costs. Self-funded plans have a choice of efficient administrators, like Maxon, who charge a lot less money for the work they do than insurance companies.

These advantages alone make self-funding a very attractive alternative to insuring your medical plan. For commercial plans there is one other advantage.

For commercial plans the greatest advantage is their ability to customize their benefits because they do not have to comply with state benefit mandates, which are a large part of the escalating cost of health care today.

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Can Self-Funded Plans be protected against large claims?

There are insurance policies called Stop-Loss policies that provide coverage which protect the self-funded plan from very large claims. Specific Stop-Loss coverage protects against very large individual claims and aggregate Stop-Loss coverage protects the plan against large losses if the total volume of claims exceeds a predetermined level. For example, in the case of specific Stop-Loss coverage if a specific level of $35,000 has been set a claim for $50,000 would trigger the policy and the plan would pay only $35,000. The Stop-Loss would pay $15,000. Aggregate Stop-Loss works in a similar fashion for total claims incurred during the course of the Plan year. If total claims reach a pre set level called the attachment point the stop loss policy is triggered.

Is stop loss payable only at the end of the year?

Typical stop loss pays upon the filing of a specific claim or at the end of the year for aggregate claims. A feature called an aggregate accommodation is available with most stop loss policies which will pay based upon monthly claims to help even out the cash flow for a self-funded plan. This feature is attractive for smaller plans.

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My company has employees all over the country. Can Maxon accommodate this?

Maxon administers plans covering employees who reside in all 50 states. We contract with national, regional, and local provider networks, and pharmacy benefit managers allowing us to provide comprehensive provider coverage wherever your employees may reside.

My company is currently covered by an HMO. Can you duplicate this coverage?

Virtually any coverage provided by insurance companies or HMOs can be duplicated, including any combination of in-network and out-of-network coverage you currently have.

Maxon will contract with one or more provider networks that best matches your employees locations base upon zip code access reports. Maxon will contract with Pharmacy Benefit Managers and design a drug card and mail order program that best fits your needs.

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