Participating self-funded Member Companies average 45 percent hospital savings when comparing actual charges to agreed rates for the past 9 years with hospital rates declining ten percent (10%) for the same period. The average Coalition member’s return on investment for members during 2003 was $150.53. One of SBG’s largest members has monthly plan medical costs of $324. Compare this to the Kaiser Family Foundation’s reported average monthly of $778.

SBG has been very successful in negotiating rates and fees that have protected our members from the double digit increases experienced by other employer.

This success extends into all aspects of the health plan. SBG participating members consistently pay less then charges for hospital services as shown below.

Payment for laboratory services is far below UCR for this area.

Contract Features:

1. Hospital Inpatient: a. Admission charges are based on DRG case rates. b. Admissions outlier protects against large cases.
2. Hospital Outpatient Surgery: a. Ambulatory surgery rates are based on APC case rates. b. Employee expenses based on lower of billed charges or agreed rate. c. Observation included in case rate.
3. Hospital Outpatient Services: a. Laboratory services available through couriers, draw sites, or the hospitals. b. MRI and CAT scan services are based on a flat dollar per case.
4. Physician Fees: a. Service charges based on a negotiated fee schedule. b. Employee expenses based on lower of billed charges or agreed rate. c. Services not on the fee scheduled are re-priced with a set discount. d. No balance billing for covered services.
5. General: a. Hospital fees are firm for one year. b. Annual hospital increases based on achievement of performance measures. c. Health System contracts are multi-year agreements. d. RFPs are used to select health systems.

Financial agreements are proprietary and are only available for review by perspective employer participants on a confidential basis.