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A MERP (Medical Expense Reimbursement Plan) is like having a backup bank just for employee health expenses. The employer funds the account, and employees receive a no-pin Visa debit card to pay co-pays and deductibles on the spot — lowering out-of-pocket costs without complicated insurance paperwork.
The minimum group size that yields meaningful savings is 15 employees. MERPs can also be set up for smaller groups where improved benefits — rather than savings — is the main goal.
Under a typical MERP, net savings is around 25%. For example, an employer currently on a $500/$1,000 deductible plan can switch to a $5,000 deductible plan — saving 30% on premiums — while still offering employees 100% coverage by funding the difference through the MERP.
Yes. MERP is specifically designed to work with Kaiser plans. Employers can purchase a high-deductible Kaiser plan at a lower premium, then use the MERP to eliminate or minimize deductibles and co-pays — retaining Kaiser as the provider.
Yes, it is possible with some insurance plans such as Kaiser. Most employers wait until the renewal anniversary to avoid confusing employees, as a mid-year change creates a new 12-month renewal cycle. Consult with Clifford for your specific options.
No — employees typically gain better benefits. The MERP is designed to deliver 100% coverage — a plan unavailable off the shelf from any carrier — while the employer pays less in total premiums.
Like-minded employers with 50 or more employees come together to form their own self-funded plan. Each employer designs their own benefit level and self-funds claims up to $50,000. Claims above that are covered by the captive pool up to $250,000, with an insurance carrier covering anything beyond. Excess funds at year-end are redistributed back to employers on a pro-rata basis.
Major PPO networks like Aetna, CIGNA, Anthem Blue Cross, and United Healthcare overlap significantly in providers — but discounts on your actual claims can vary by 10% or more. A review of your claims identifies the most competitive network, plus the best large claims case management to further reduce costs.
RBP addresses the high cost of hospital charges by using Medicare as a benchmark plus a reasonable profit margin of 25% — instead of the traditional PPO contracted discount of 25–40%. This creates savings on hospital claims of up to 30%.
As organ transplants become more common, their cost impact on employer plans grows. Instead of absorbing the full transplant cost into the plan, a targeted insurance policy purchased at a small premium covers the transplant directly — resulting in lower renewal increases long-term.
Prescription drugs represent about 25% of total health plan claims, and specialty drugs are rising fast. Strategies include finding the most competitive Rx vendors, patient care management to reduce unnecessary prescriptions, sourcing specialty drugs from Canada, and negotiating drug rebates back to the employer instead of letting carriers keep them.
Hospital bills are almost always created with errors. GHHS has bills audited by an independent firm to identify and report total errors — recouping savings that directly lower your total claims cost.
Kaiser's group therapy approach often falls short of individual needs. Through the MERP plan, employers can fund access to licensed mental health providers outside the Kaiser system — giving employees the one-on-one therapy they need, fully covered by the employer's MERP account.
Self-funded health plans can now offer stem cell therapy coverage for certain procedures as an alternative to expensive operations. Stem cell infusions can reduce the cost of treatment by as much as 80% — significantly lowering total claims for the employer's plan.