Product Offers Help to Consumer Directed Health Plans

April 7, 2003 ( - Member plans in the American Association of Health Plans (AAHP) are being offered a special price on a computer system to help them with everything from plan design to marketing.

According to a joint AAHP announcement with CareGain, the CareGain Defined Care Platform will help the more than 1,000 AAHP member health plans run on a consumer-directed health program basis. The CareGain product gives lets plan administrators offer plans using Section 105 Health Reimbursement Arrangement Accounts or CareGain’s own Defined-Care model.

In the Defined-Care model, employers provide a set amount of health care dollars for each employee per year. Employees use those dollars to pay for health care services for themselves and their family. At year-end, a dividend based on employees’ judicious use of health care resources is distributed to the employee-owned, private and portable HealthcareIRA accounts, where these funds can roll over on a tax-free basis year-to-year, and can be made available for future or retirement health-care needs, according to the announcement.

In terms of specific services, CareGain provides:

  • plan design
  • actuarial support
  • enrollment and eligibility functions
  • claims adjudication and account balancing
  • a member-decision support system.

According to the announcement, CareGain’s systems include many of the provider cost and quality tools, prescription drug cost information tools, medical records, account management functions, and formulary and benefit communication tools that are required to support members enrolled in consumer-directed health plans.

CareGain provides health plans the ability to administer internally using CareGain’s systems or to outsource the administration.  CareGain also offers an “ASP” option to enable health plans to go to market within four to six weeks with their own branded products. For more information, go to .