Frequently Asked Questions
Group Health Plan Benefit Administrators
Employer self-funded health benefit plans operating under ERISA and multiemployer and labor unions health and welfare benefit programs operating under Taft-Hartley. Some employers that are "self-insured" (government authorities and municipalities) also work with us because we offer US choices for healthcare in addition to international destination choices. The latter is far more complicated because of the state insurance rules and regulations and timely filings of plan documents for review by regulators that is involved. For employees and beneficiaries of our clients who would like to travel for care or wellness travel (to a spa or health resort, for example) or require a self-pay, non-covered procedure or service, we always accommodate them as a courtesy to our client. Our business relationships with providers afford us powerful competitive leverage that we can apply to arrange great discounts.
Client-unaffiliated self-pay consumer
On occasion, we've been known to help a client-unaffiliated self-pay consumer, but our business model is not really set up for that. This is more often the case when the inquiry comes from friend or family of our staff or for compassionate reasons requiring the level of complexity our system can handle with ease. You can always call us and ask, but the likelihood of arranging a trip to a destination or provider where we have no existing relationship and no Approved Providers is highly unlikely. The cost of vetting and research a new Approved Provider facility or physician is prohibitive because we will not deviate from our standards and Approved Provider criteria except under very rare and extenuating (emergency) circumstances.
For one-off cases not affiliated with a client employer or union account, we often refer the enquirer to "retail" health and wellness tourism coordinators whom we know well and work closely. We take no commission or cut from any referral we make to a provider or other "retail" health and wellness tourism coordinators.
On average, our experience has been that about 5% of your plan population's incidence frequency rate will elect to travel. This can vary depending on where the population normally resides.
This can vary greatly company to company. In areas where there is healthcare scarcity (rural and remote areas, in particular) some travel may be required for most tertiary care. In areas where local care complex care is present and accessible, fewer people may elect to travel unless the network you've designed includes treatment choices at a high-profile, branded Center of Excellence (e.g., Cleveland Clinic, Johns Hopkins, Mayo Clinic, Cancer Treatment Center of America, Sloan Kettering, etc.) We've had situations in the past where the plan medical director was so unimpressed with the quality and outcomes of local care, he wanted to set up a medical travel program that was a driveable distance (~3 hours each way) away but where certain specialty care was arranged including hotel and special pricing. He preferred to spend a little more on care cost, mileage reimbursement, and hotel accommodation than continue paying for care that was, in his professional opinion, substandard and low value.
In another instance, we identified a spine surgery Center of Excellence that was 90 miles from the community in which the company was located, but the savings was nearly $80,000 per lumbar fusion or laminectomy case. The SIC category of the workers had a higher than average historical utilization of herniated discs, and many workers and dependents were overweight, most of whom carried their weight in their abdomen, and had higher than normal disc deterioration. This was exacerbated by the type of work they performed every day. We set up the program so that they didn't have to fly to have surgery, but could instead drive 90 miles in each direction. All the other medical travel logistics were still required to set up the program. The cost of program setup and case management was neutralized upon realizing the savings from the first case carried out.
Understanding Incidence Frequency Ratios
The basic incidence frequency rate (sometimes called just incidence) is a measure of the frequency with which a condition occurs in a population over a period of time.
How Incidence is calculated: Incidence Rate = (new cases occurring during a given time period/population at risk during the same period) x 10n
How we use the data to estimate program utilization and design
We use your population health data, a look back at past claims, any lasered claims, and determine if a medical travel program makes sense for your organization. We take into account cultural and language factors, political leanings, costs, logistics, and many other critical elements to complete your situation assessment and make our recommendations for your program. We examine both health plan claims and workers comp, when applicable.
Later, we leverage this data in order support your book of business value proposition when negotiating exclusive rates with candidate Approved Providers you've shortlisted for consideration. We also use the data for our own staffing and planning at Mercury Health Travel to determine if we'll need to ramp up adequate staffing to manage your benefit program for you.
Beyond this it is not prudent to set expectations of "X" number of cases per thousand plan participants. This is because volume is dependent on too many variables to make such an assumption without knowing which surgeries or services are targeted, what the uptake will be, and what it will cost. Instead, we prefer to set up a program where a minimum $15,000 savings per case will be the experience. If you save more, that's wonderful!
Our Brand Integrity Means Something To Us
We're very fortunate in that we don't live and die by the corporate medical travel administration projects we complete. Some of our competitors only have one revenue stream: To sell you surgery packages.
Medical travel benefit options may not be right for your company.
We won't set up a program for a client if the program will lead to higher costs and participant dissatisfaction because doing so jeopardizes your self-funded plan fiduciary compliance. If we can't keep you compliant, save you money, support your loyalty duty to participants and mitigate unnecessary plan costs, but you want to do this anyway, we may refer you to a competitor rather than jeopardize our brand ethics and reputation to comply with your request.
We offer any procedure required by our clients. The most common procedures for surgery include those where the employer can save at least $15,000 on the procedure compared to local and wrap network options near where the employee or beneficiary regularly resides.
Mercury Healthcare International differentiates itself from our competitors by offering the following:
- The world's only globally integrated health delivery system® covering 120+ countries and all US states and territories
- No commissions accepted from Approved Providers (medical and dental providers, facilities, labs, etc.)
- Exclusive wholesale corporate pricing unique to each client - often up to 30% less than Internet-advertised medical tourism prices
- Full-service TPA capable of processing bundled claims for an episode of care
- Medical and travel price "Meet or Beat" policy
- Our specially-trained medical travel planners working through a regulated travel agency
- Our specially-trained nurse case managers coordinate continuity of care
- Airline discounts of up to 60% in international business class fares exclusively negotiated for our clients
- Discounts on medical traveler appropriate hotels and alternative accommodations exclusively negotiated for our clients
- We focus solely on assisting corporate health benefit plan sponsors, a market size of roughly 80,000 organizations with up to 1000 plan participants (1600 lives)
- Monitored outcomes measurement and reporting for extended periods (usually 36 months) based on our proprietary metrics and other criteria
Please see our Procedures page to learn about other services and programs available. These include, but are not limited to:
- Executive Checkups
- Second Opinion Consultations
- Substance Abuse & Rehab
- Travel Dialysis
- Courtesy Case Coordination
- Workers Compensation Case Coordination
- Medical Evacuation and Airlift
- MICE & Medicine®
- We first set up a medical travel benefit framework with a corporate client (employer, labor union, association, etc.)
- Plan participants access a secure, online information portal that explains the Plan's unique program, destinations and Approved Providers and Facilities
- Plan participants may call us directly to learn more about the program and pre-determine eligibility and medical clearance requirements to travel for care
- Once green-lighted, MHT's case managers and travel planners arrange all travel and care continuity.
- Travel commences and upon arrival at the health or wellness destination, the plan participant and companions are met by a local arrival coordinator who delivers a welcome kit that is pre-arranged by the plan sponsor.
- All transfers to hotel or clinic are pre-arranged and managed by vetted ground transfer services
- Upon discharge from destination care and receipt of a "fit-to-fly" certificate, a departure coordinator escorts the plan participant and travel companions through the departure process up until the security checkpoint.
- Upon return to the home city, departure coordinators continue to remain involved through any aftercare and beyond, through the period of outcomes measurement and assessment
Mercury Health Travel's business model is not designed to handle medical tourism package sales for persons not associated with our group health clients.
We specialize in helping self-funded health benefit plan administrators to design a medical travel benefit offered through the health benefit plans they administer. Once their unique program is designed, Mercury Health Travel's care coordination team manages the travel and care navigation for plan participants of that client company through an ongoing Service Agreement. Our TPA manages all provider fee settlement at a corporate level.
There are many medical tourism companies who compete in the "retail" medical tourism consumer space. Their services are available to individuals who intend to pay-out-of-pocket for medical tourism services. They work at a different level obtaining quotes and selling packages of medical tourism with their network partners. They also manage all the self-pay retail payments that we don't get involved with.
We collaborate with medical tourism facilitators in Canada, the USA, Ukraine, Germany, and throughout Asia. If you contact us as an individual, we'll probably refer you to a facilitator who is a client of our consulting firm through the Mercury Advisory Group or the Center for Health Tourism Research, an end user of the Higowell medical tourism facilitator software platform, or with whom we collaborate and trust from prior association. We believe it is rude, unethical and a conflict of interest to compete directly with the clients who trust us to help them grow their business.
If you are self-employed and/or don't have any insurance
For those who are uninsured or underinsured and need medical care, we may have a solution for your consideration. This involves purchasing a health insurance policy in a narrow network product that is only available outside the USA. Call us to learn more: +1 (800) 209.7263 Mention "ACUNES-MHT" so that the switchboard receptionist knows how to direct your call.
To the best of our knowledge, a "medical tourism insurance" policy specific to medical tourism coverage is rare, if one exists at all. Some attempted to enter the market and failed in short order. The reason that it is rare is because of 3 reasons:
- The likelihood is high that the policy would only be purchased by people intending to use the policy - this is called "adverse selection" in the insurance industry - meaning, in short, "when people with known high cost risks choose your product". Adverse selection risk is typically mitigated by policy holders who never submit a claim. The ration of medical tourism insurance policy buyers to users would likely be 1:1.
- The underwriters and actuaries would not know how to assess the financial risk of the utilization and covered services - which creates a problem for regulators who oversee "insurance" programs. Regulators must verify the actuarial projections and underwriting assumptions to determine if the premium is set at a level high enough to cover anticipated risk. Premium calculations are often vetted 2 years in advance of selling the first policy. This allows for the regulators to do their work, pushback questions for clarification to actuaries and underwriters, and to train insurance sales agents to sell the policy.
- The cost of network development for an empanelled network of providers to be contracted to accept the fee schedules as payment in full would cost the health plan roughly $15,000 per facility (at a minimum). And that's if credentialing and privileging of doctors and dentists is delegated to the participating facility. If not, network development costs and site visits would be cost prohibitive and take years to build an adequate network. Since network adequacy is determined by the number of policies sold and estimated utilization patterns, network adequacy would be difficult to establish.
One alternative is not to establish an insurance product solely for the purpose of medical tourism. Instead, a company could add a benefit option to an existing plan sold to cover most traditionally covered health care claims for medically necessary services, and add the option to travel for care as a plan participant's choice. This is what we help Plan Administrators at self-funded employers and multiemployer groups (unions, associations, etc.) to arrange.
Mercury Health Travel's typical clients are employers and unions of self-funded health benefit plans with 50-1000 plan participants and dependents. In the USA, about 80,000 of these employers and unions exist. They no longer pay premiums to a health insurance company to cover employee and eligible dependent health claims costs. They set their own rules, design their own plan, and negotiate with providers directly or access existing networks of providers through a PPO, TPA, or ASO. (An ASO is a group health self-insurance program for large employers wherein the employer or labor union assumes responsibility for all claims risk for covered services, purchasing only administrative services from the insurer.) For these companies, a medical travel program can be embedded as a pilot program at first and then later expanded if the reception by employees and dependents is positive.
Working with health tourism destination development clients in Central Europe, our experts identified a potential alternative if you don't have a catastrophic policy, are ineligible for a catastrophic policy, or otherwise uninsured. You must be open to traveling to an international destination in Central Europe for care. You should be eligible to enter the country as a regular traveler. If you have no medical insurance, can afford to write a check for about $4000 plus your travel expenses. This policy covers most medically necessary (not cosmetic) surgery, dental care, rehabilitation, dialysis travel coordination or high-cost diagnostic testing or cancer staging, required prescriptions, and more. The program runs Jan 1-Dec 31, and covers you for the entire year, not just the single episode of care. The majority of the care will be rendered in Central Europe in a narrow network through a program that resembles a staff model HMO. A JCI-accredited Approved Provider in our network is associated with the program. Naturally, it covers emergencies outside of Europe according to policy limits and exclusions.
Some waiting periods apply for specific services and conditions. Other conditions and services are covered right away. The program is not intended for regular use to cover claims incurred within the USA. It is intended and designed so that the majority of your care will be rendered at the affiliated partner hospital in Europe. It is not "travel insurance". To the best of our knowledge, this program is intended as full coverage, private medical and hospital insurance for local residents of that country, but is available to anyone willing to pay the premium and follow the in-network rules to obtain services. A sworn affidavit of certain representations about your health is required, probably having to do with full or partial exclusions related to pre-existing conditions. So if one is ready to follow the rules and self-pay for travel to the treatment destination for elective care, one might save tens of thousands of dollars if one requires costly healthcare that one cannot otherwise afford.
One will probably be asked to pay the insurance policy premium annually, in advance. The premium amount is set actuarially by age and gender and ranges about $2500 to $4000 per year. We are unsure about pre-existing exclusions, copays and other matters. We'll direct you to someone qualified to answer your questions rather than venture a guess. To go beyond that level of detail beyond our scope of expertise. Insurance policy interpretation is a regulated profession for which this author lacks the proper European and local agency credentials.
If you choose to purchase a policy through this program, Mercury Health Travel will help you coordinate your care and travel plans to the Approved Provider(s) in Europe.
To be referred to the program and a qualified sales agent, call 1 (800) 209.7263 (9-5 Mountain time) and mention "ACUNES-MHT" so that our switchboard receptionist knows where to direct your call. Since we don't sell any insurance, failure to mention "ACUNES-MHT" will cause the switchboard receptionists to respond as if you dialed a wrong number and they will not transfer your call, and instead advise that you we don't sell insurance.
DISCLAIMER: We are not insurance agents for the program, and we are not paid any sales or referral commission, in cash or in kind, to connect you to the appropriate parties to help you further.
Our Approved Provider network includes more than 65,000 Approved doctors, dentists and therapists, over 9000 Ambulatory Survery Centers and over 5000 general, tertiary, rural and academic medical centers from which to choose across the USA. Tell us which destinations you would like to include and we'll narrow down your choices and get your program up and running very quickly.
No matter where your company is organized, headquartered or where your branch offices and work sites are located, if they located on Earth and you administer a self-funded group health benefit program, we can help you.
We haven't quite worked out the details for lunar or interplanetary logistics or how to accommodate those working on the ISS just yet.
But be sure to sign up for our newsletter and we'll be sure to send you an update (just kidding!)
Not at all!
While most of our clients are U.S. corporations, we welcome any employer or labor union with a self-funded group health benefit program to work with us.
Self-insured companies and multiemployer health and welfare programs (MEWAs) pay for workers' health care costs directly and bear the risk associated with the year-to-year fluctuations in health care expenditures. Self-insured employers and MEWAs can mitigate some of the risk by purchasing stop-loss insurance, a type of reinsurance for self-insured employers. In a typical stop-loss arrangement, the reinsurer agrees to pay a proportion of medical expenses (for example, 80%) if claims for an individual are above a threshold, or attachment point (for example, $75,000). Some self-insured employers also purchase aggregate reinsurance, in which the reinsurer agrees to pay claims if aggregate medical expenses for the group are greater than some percentage (for example, 125%) of the expected expenditures for the group.
In contrast, fully-insured companies pay a fixed premium per enrollee to a health insurance issuer with the health insurance issuer bearing the risk for paying claims.
Self-insurance offers a variety of potential advantages to employers, including:
- Autonomy, control, and flexibility over the plan design, including exemption from state mandated benefit requirements;
- Lower administrative services costs than would be charged by a commercial carrier;
- More timely and complete access to data on health claims to help make more informed decisions about the design of their health plan;
- Ease of altering their contract with a third party administrator (TPA) or stop-loss insurer without affecting their employees choice of providers;
- Improved cash flow generated by keeping funds in-house until needed for payment of claims; and
- Avoidance of state insurance premium taxes.
Self-insurance also has potential disadvantages relative to the purchase of a fully-insured product, including:
- Financial risk of unexpectedly large claims;
- Regulatory compliance, which is easier with a fully-insured plan.
Larger groups are much more likely to offer a self-insured plan than are smaller groups. Self-insurance is riskier for smaller groups because small groups have fewer employees over whom to spread the risk of costly claims. A medical travel program, when structured properly, can save plans significant costs by leveraging special direct-with-provider contracts for steered healthcare service volumes. Price arbitrage in health services can tip the needle in favor of the health plan, as long as the quality and safety of the substitution are similar. This practice of taking advantage of a price difference between two or more markets is what powers the argument of medical travel in the group health environment - trading steered volumes of otherwise inaccessible cases with hospitals and clinics for discounts: striking a combination of matching deals that capitalize upon the imbalance, the advantage to the plan being the difference between the market prices.
Plan administrators and fiduciaries are duty bound to save the plan assets whenever it makes reasonable commercial sense to do so. They are also duty bound to place the interests of plan participants and beneficiaries first. When a medical travel option affords higher quality care, quicker access to care, or some other advantage over the local PPO in-network arrangement, the Plan Administrator is duty bound to consider the option upon request of a plan participant.
Based on 2009 data from the Medical Expenditure Panel Survey, Institutional Component (MEPS-IC), 82 percent of large firms (500 or more employees) offered at least one self-insured plan compared to 13 percent of small firms (under 100 employees). As shown by Figure S-1, over the period from 2002 to 2009, there has been a trend toward self-insurance among larger firms (increasing from 77 percent to 82 percent), while remaining flat for smaller firms (13 percent).
Percent of Private-Sector Establishments Offering Health Insurance That Self-Insure at Least One Plan (Figure S-1)
Source: HHS analysis of data from the Medical Expenditure Panel Survey- Insurance Component.
In the past tis didn't happen much. During the 1990s, groups under 500 lives operating in multiple states were assumed to be self-funded / self-insured. Then the premium increases and taxes were so cost prohibitive that groups around the 350 lives market started transitioning over to self-funded / self insured. Now, it is possible to find groups with only 10 lives attempting to transition to self-funded / self insured.
The extent to which small employers move to self-insurance depends on the reinsurance market. Because there is little data available, many experts researchers believe that attractively-priced stop-loss with low attachment points is not currently widely available for small employers.
It is unclear whether the reinsurance market will change substantially, although there are some anecdotal reports that reinsurance with relatively low attachment points is becoming more widely available. AmWINs had talked about a product that would become available to consolidate several small employers into reinsurance pools, but we never heard much more about it beyond the "it's being discussed" message.
If the reinsurance market were to change, and attractively-priced reinsurance providing coverage beginning at low levels of stop-loss became widely available, then there would likely be substantial movement of small employers to self-insurance. A similar shift would likely occur in the current market if such a product existed today, although the incentives to move to self-insurance for small employers with younger and healthier workers are expected to be somewhat greater going forward. Especially if the wellness programs can see higher utilization.
According to Deloitte FAS analysis of the publicly available data filed by plans, industries that appear to be more likely to self-insure are those in agriculture, mining, construction, manufacturing, transportation, utilities, and finance/insurance/real estate, when adjusted for plan size. Less likely are those in communications and information, wholesale trade, retail trade, and services.
RAND's analysis of Kaiser/HRET data found that, when not controlling for firm size, the rate of self-insurance is higher among firms in healthcare, manufacturing, transportation/utilities/communication while they are lower in retail and the agriculture/mining/construction industries. Both the Deloitte FAS and RAND analyses indicate that the manufacturing industry is more likely to self-insure, and the retail industry is less likely to self-insure, but many other industries appear to be more likely to self-insure in one analysis but less likely in the other.
One could safely assume that most Fortune 1000 companies are self funded/ insured for group health benefit programs, including medical, dental, workers compensation, and behavioral health. They may pay an insurance premium for travel accident and illness insurance, IPMI for expatriate workers,
According to the Center for Health Tourism Research, while examples in recent years of medical travel program implementation include companies such as Walmart (retail), Lowes (retail), Dillards (retail), Delta Airlines (transportation), Serigraph (manufacturing), Hansen Foods (retail), B&H Photo (retail) and PepsiCo (manufacturing /bottling), they may simply be anecdotal examples of enormous account size, but not a reliable indication of trend or likelihood of future growth in corporate medical travel for group health. Smaller firms, such as Blue Lake Rancheria, a Native American firm that operates a casino in California, have implemented medical tourism pilot programs with reasonable success and participant satisfaction.
More hospitals across the USA are looking to soften tough economic times and fill beds by extending their market shares to medical travel opportunities for business development. They view business coming from a same-day round trip drive radius as new market share not previously considered or targeted. If an employer wishing to do business with them can give some indication of how much they might buy over the course of a year, the hospital is willing to discuss and negotiate a direct-with-employer contract. The amount of the discount is usually tied to projected utilization. For this reason, we review and leverage past claims data and predictive modeling outputs along with relevant data from lasered claims in order to develop the negotiation strategies and objectives for our clients.
Experts from the Mercury Advisory Group Managed Care Practice have been negotiating and mediating relationships between employers and healthcare providers for decades. At first the practice was almost 100% local business. Now the geography has expanded. The added cost to the hospital is generally associated with logistics coordination activities. Many of the health facilities (ASC and acute care hospitals alike) that wish to enter health tourism call upon Mercury Advisory Group experts to assist with bundled case rate development and LEAN process improvement in the operating theater for internal cost containment. Often, they also request assistance for marketing and branding strategies and plans to enter medical tourism.
Mercury Health Travel was originally launched as a response to the specialized case management and logistics coordination for health travel clients connected to these arrangements. In 2013, the company reviewed and updated its strategy to focus only on group health clients and no longer accept individual consumer case coordination for individuals except in rare cases for friends and families of Mercury Healthcare International staff and clients.
The majority of our work is case coordination to US hospitals, referred to in the industry as "interbound" medical travel. About 20% of the cases we coordinate are cross-border bound.
In the case of labor unions, across America, the preference is to remain in the USA and not purchase foreign exports such as healthcare services. By limiting their choice to US health facilities only, they have over 6000 hospitals and 9000 ambulatory surgery centers nationwide from which to choose as destinations for their medical travel program.
For companies who employ workforces with duty stations outside the USA, the trend is to identify and empanel designated Approved Providers within 2-hour concentric flight circles around the worksite rather than return all the way back to the USA.
Mercury Health Travel would be pleased to discuss your needs and objectives. It will be much easier if you tell us that you have or do not have population health data and any predictive modeling output reports. If you do not have such data available, we can still help, but will likely ask that you allow us to involve our staff medical epidemiologist to help complete the initial situation assessment.
We begin with a situation assessment to determine if medical travel is feasible for your organization and to what extent. This enables us to recommend specific pilot programs and estimate costs and savings, if any.
Frequently, we find that requests from outside the USA are generally more oriented toward coordinating care to affordable destinations where the care is of a higher quality and technology, or quicker access to care and clinical trials than what is available locally, rather than a search for cheaper pricing.
In the case of VIPs in our Healthcare Checkup Programs, clients from the USA and abroad both ask for upmarket luxury choices within the USA, in Spain, Singapore, Thailand, and the UK. Because one past client was a large international shipping concern, we expanded our Approved Provider network to include Approved Facilities and Providers in most major shipping port cities.