Five reasons why you should use Benefit Modeler

Make more informed plan decisions

Modeling results are customized for your organization’s specific healthcare experience, helping you to identify potential savings opportunities and negotiate with providers to receive the best rates. The tool can help you measure the impact of in-network and out-of-network utilization on plan usage and cost, as well as plan more effectively for collective bargaining or benefits consolidation because of a merger or acquisition.

Get ACA compliance alerts

Benefit Modeler helps meet Affordable Care Act (ACA) compliance obligations by using alerts when your design scenarios raise ACA compliance issues. The alerts include ACA compliance for emergency room, preventive services and out-of-pocket maximums. It supports the US Department of Health and Human Services Minimum Value Calculator reporting. Thus, Benefit Modeler becomes a one-stop resource for plan design validation by including the needed values to produce a pass/fail report for plan options.

Address the consumer-driven trend

Using insights from Benefit Modeler, you can more easily decide whether to implement a new consumer-driven healthcare program or modify existing benefit program designs. You can model the changes to plan parameters from a financial and consumer perspective, design the benefits and determine the best employee premium contributions. You can also assess projected employer and employee expenses funded by health reimbursement, health savings and flexible spending accounts.

Perform more sophisticated analyses and modeling

Benefit Modeler allows you to achieve a variety of tasks, including: 1) Disruption analysis to calculate true employee out-of-pocket costs – including contribution rates. 2) Demographic analysis to model the effect of demographic and geographic shifts. 3) Model consumer-directed health plan options, including health reimbursement accounts and health savings accounts. 4) Compare and validate HMO premium renewals – including validation of benefit design modeling by consultants or health plans.

Gain access to a powerful IBM MarketScan database

IBM Benefit Modeler is built on a large pool of actual claims data from one of the industry-leading, proprietary databases – the IBM MarketScan Commercial Claims Database. The database contains more than 175 million patient lives since 1995. It includes 60 million inpatient hospital discharges and houses 20 billion records. You gain access to data about patient copayments, mail order, injectables, specialty pharmacies and most carve outs – both manually and electronically submitted.