Employees and dependents identified by the employer as “eligible participants”. These eligible participants are generally those that are covered under the health plan.
According to the Society of Professional Benefit Administrators (SPBA), the IRS has stated that on-site clinic programs, that are limited to primary care and similar services, are not health plans. As such, the IRS has indicated to the SPBA that specific guidance on this issue is not necessary with regard to HSAs. As with all IRS matters, it is recommended that you consult with a tax advisor in the event of questions regarding the use of an HSA.
All the actual costs of running a clinic are passed through to the employer with no markup. Generally, WeCare TLC’s clinics cost an employer about $65-$70 per eligible employee per month (PEPM). These operational costs will vary slightly from month to month. Included in the $65-$70 PEPM total operating cost is our management fee that covers the costs of clinical corporate oversight, centralized infrastructure (like information technologies), Lifestyle Management, and data warehousing/analytics.
Do you recommend using incentives?
Absolutely. During the implementation process we will work with you on establishing incentives and disincentives that will most effectively guide your employees to the clinic.
What level of participation can we expect in the clinic’s first three years?
WeCare TLC will collaborate with the employer’s human resources department to orient employees.
How do you involve new employees in the Health Risk Appraisal (HRA) process?
When employees become eligible for the clinic, WeCare TLC will collaborate with Employer’s HR to orient the employee. An HRA should also be included in all new hire packets.
To have a full time (40 hr/wk) clinic will take approximately 1100 employees.
We encourage smaller employers to join in collaborative clinics. The clinic can be located conveniently for everyone involved, and patients from different employers can be easily tracked so costs are correctly assigned to the proper account. Please contact us for more information.
Our clinics are full service primary care offices anchored by physicians. You would be able to receive any service that would normally receive at your doctor’s office. Please click here to see our standard clinic offerings. All services are provides at no cost to the employee or their dependents.
Most employers do. The clinic provides comprehensive primary care for personal and occupational health issues, but it still makes sense to carry coverage for major medical events.
All services rendered in the clinic are at no cost to the employee.
WeCare TLC clinics use a physician-led care model. The goal of this arrangement is to make the clinic the medical home for employees and their families, and by doing so provide superior care at lower cost than is typically available through the health plan network.
WeCare TLC employs all clinic staff. We also carry all necessary liability coverage, including med mal. Our recruiting team places all job openings, pre-screenings, credentialing, etc. The employer is able to choose their level of involvement in the hiring process.
Employees should receive all the same services that they would receive in a regular primary care physician’s office, except the experience will be more personal and will not take the majority of the day.
Because the needs of children – and especially very small children – are so different, WeCare TLC only provides convenient care for children 2-10 years and routine care for children older than 10 years. We believe children under 10 years should be seen by pediatricians for milestones and other routine care. If the employer provides coverage for a sizable pediatric population, it may be appropriate for WeCare TLC to contract for a part-time pediatrician onsite.
WeCare TLC will negotiate rates with providers in the employer’s network and encourage patients to visit those facilities when the clinic is closed. WeCare TLC can also arrange for telemedicine services at an additional fee.
Ultimately, the impact on the plan’s claims experience provides the best indicators of the program’s performance. WeCare TLC’s reports track improvements in risk categories, behaviors and overall health care spend.
WeCare TLC strictly adheres to HIPAA’s privacy and security regulations.