Products & Services Offered
Great-West Healthcare refers to products and services provided by Great-West Life & Annuity Insurance Company and its subsidiaries (Alta Health & Life Insurance Company and Great-West Healthcare HMO/HCSC companies). It also refers to New England Life Insurance Company's and Metropolitan Life Insurance Company's group business currently administered by Great-West. Great-West Life & Annuity Insurance Company is not licensed to do business in New York. Products are sold in New York by its subsidiary First Great-West Life & Annuity Insurance Company, White Plains, N.Y.
The product and service descriptions on this Web site are not intended to be offers to sell or solicitations. All products are not available in all areas and are subject to applicable regulations.
Legal Notices Regarding our Web Site
- Information on this Web site is provided “AS IS” without warranty of any kind, either express or implied, including but not limited to the implied warranties of merchantability, fitness for a particular purpose and non-infringement.
- Great-West Healthcare has no obligation to update information presented on this Web site. The information on this Web site might be out of date at any given time. Changes, revisions or enhancements to Great-West Healthcare products, services or account information described on this Web site can occur at any time and without notice.
- Great-West Healthcare is not rendering any legal or professional service by placing information on this Web site. Covered persons, clients and others viewing information regarding products, services and account information should contact a Great-West Healthcare representative directly before making any decision based on information found on this site.
- This Web site is neither designed nor intended to advance or sell any particular product or service. Any reference to Great-West Healthcare products or services is purely for illustrative and informational purposes.
- Except as otherwise disclosed, all trademarks and service marks contained in this Web site are the property of Great-West Life & Annuity Insurance Company.
- Unauthorized copying, reproduction, duplication, transmission or use of the information contained on this Web site is prohibited.
Great-West Life & Annuity Insurance Company Disclosure of Financial Arrangements to Group Health Plan Clients
Purpose of Disclosure
Great-West Life & Annuity Insurance Company ("Great-West") is providing this disclosure to inform group health plan clients of (i) compensation that Great-West pays to others; (ii) its primary source of revenue, and (iii) revenue that Great-West receives from third parties. Great-West wants our clients to understand the impact on client rates of revenue received and compensation paid by Great-West.
Compensation to Third Parties
Great-West pays compensation to third party brokers and insurance sales people for placing a contractholder’s or policyowner’s ("Clients") business with Great-West. This compensation is typically in the form of a percentage of premiums collected or a fixed, per-employee per-month rate.
Great-West may pay additional compensation to brokers and insurance sales people based on persistency or other non-case-specific factors, sometimes referred to as “contingent commissions.” This additional compensation is not part of the regular commissions.
Great-West discloses compensation paid to brokers or insurance sales people on the Annual Return and Report (Form 5500). Many employee benefit plans are required to file the Form by ERISA and the Internal Revenue Code. Great-West will also disclose how the client may receive more information directly from the broker regarding compensation arrangements.
Primary Source of Revenue
The primary compensation Great-West receives with respect to its policies and contracts is from Client-paid premiums and services fees.
Other Revenue Sources
Great-West negotiates for additional revenue from some third party vendors. Great-West negotiates the additional revenue as part of the overall structure of each vendor agreement. The nature of negotiated contracts with vendors is that they are generally based on the aggregation of all business related to the contract and are not Client-specific. This fact makes it difficult to determine the impact of this revenue for any one Client.
Great-West retains this additional revenue for its sole and exclusive use, applying it in part to the overall cost of maintaining Client programs and other business expenses. The aggregate revenue generated from the third party vendors, including programs designed to effect cost savings for the Client, allows Great-West to cover the cost of client programs and other business expenses and to offer lower premiums and administrative fees to its Clients.
Great-West may offer programs and services where a third party vendor supplies all or part of the program or services. The claim amount charged to the Client for the program or services includes both an amount to cover the vendor fees and an amount for Great-West’s related and other expenses. The disease management program is an example of a vendor program where Great-West may charge the Client more then Great-West is charged by the vendor for the program.
Another example can be found in the rates for pharmacy benefits negotiated with a pharmacy benefit manager (PBM). The rates charged by Great-West to a Client are typically expressed as a percentage discount from average wholesale price . Great-West may offer lower discounts to the Client than the discounts that Great-West is offered by the PBM. Great-West may obtain or retain all or a portion of drug manufacturer revenue that it receives from the PBM or directly from the drug manufacturer. This revenue may be based on membership volume, volume of drug usage or placement of a drug on the formulary. Great-West’s drug formulary changes occasionally based on clinical efficacy, net drug cost and market share considerations. Member reimbursements will differ depending on where the drug falls in the formulary. Changes to the formulary can impact the revenue paid by drug manufacturers to Great-West or the PBM.
Great-West may also receive transition fees when it changes third party vendors. These fees are paid to Great-West by the vendor to cover expenses such as staffing or administrative changes that Great-West incurs during the transition. Great-West may receive marketing fees or commissions from vendors for placing the business with the vendor. These may be calculated on a per-member per-month (PMPM) basis, flat rate, or on a percentage basis.
Great-West may receive other compensation from its third party vendors. For example, Great-West may receive payment for the development and installation of special computer systems or programs necessary for Great-West to deliver a particular service to its Clients.
Great-West may receive performance guarantee payments if a vendor does not meet performance targets.
Great-West uses a specialized vendor to negotiate discounts for large out-of-network (OON) claims. When a large out of network claim is received, Great-West’s vendor will negotiate with the provider to obtain a lower rate, or discount, to the charges. The amount for the claim charged to our Client will reflect the discounted charges and an administrative fee will be charged for providing the savings program. Similar savings programs are in place for secondary networks and to audit large, complex hospital claims.
When a third party should have been responsible for the claims incurred by a member (as a result of an automobile accident, for example), after paying the claim, Great-West may try to obtain reimbursement from the third party source. Great-West currently pursues reimbursement using a specialized subrogation vendor. For successful efforts, a percentage of the recovery is retained by Great-West. Additionally, Great-West has priority right to reimbursement of any stop loss payments. Any excess is credited to the Client.
In most situations, Great-West processes claims directly and the claim amount collected by Great-West from the Client equals the amount paid to the provider. Where a third party manages a particular type of medical service, a portion of the claim amount paid to the third party may in turn be paid to Great-West by the third party to cover Great-West’s costs of administration and other business costs. A Member's coinsurance, deductible and lifetime maximum are calculated based on the entire claim amount including the portion retained by Great-West to cover costs.
Revisions to Disclosure
This disclosure may be revised from time to time and any updated disclosures will be available on our Web site at www.greatwesthealthcare.com or www.mygreatwest.com.