Benefit Modeler

Keeping high-quality healthcare accessible, while balancing the cost to both the organization and the individual, is a challenge requiring creativity and a firm grasp on the financial impact of plan design changes. By understanding the needs of a specific population and tailoring medical and prescription drug benefits to match those needs, you can deliver high-quality outcomes and reduce costs, all while ensuring compliance.

The Truven Health Benefit Modeler is an online tool that supports employers, health plans, and benefits consultants in the evaluation of a broad range of plan types including high-deductible health plans (HDHPs). Benefit Modeler alerts you if design scenarios are not compliant with Affordable Care Act (ACA) requirements for ER and preventive services and out-of-pocket maximums. It also supports HHS Minimum Value Calculator reporting, making Benefit Modeler a “one-stop” resource for plan design validation by including the values needed to produce a pass/fail report for each plan option.

The Truven Health Benefit Modeler provides the information you need to answer such questions as:

  •     What will the financial impact of proposed plan design changes be over the next five years?
  •     Are my plans compliant with ACA mandates and HHS Minimum Value requirements?
  •     Are my plans right for the targeted populations?
  •     Should I implement or expand HDHPs  to control costs?
  •     Will a defined contribution approach save money?
  •     How much should individuals contribute to their healthcare?
Design the Best Plans for Your Population

Benefit Modeler's easy-to-use interface allows you to confidently make benefit plan design decisions specific to your situation. The model is based on data from our proprietary Truven Health MarketScan® Commercial Claims database, representing 36 million lives and all 50 states. Using actual claims cost and use experience, industry group, enrollee age/gender, and geographic distribution, we tailor the modeling results to your specific healthcare experience.

With Benefit Modeler You Can:
  • Compare up to five plan designs at once to determine which best meets your goals
  • Plan more effectively for collective bargaining and benefit consolidation as a result of a merger or acquisition
  • Evaluate public and private exchange options, including health funds
  • Budget accurately based on projections derived from your own population data
  • Establish a consumer-driven health plans strategy that best matches your needs
  • Examine provider selection by measuring the impact of in-network and out-of-network utilization on plan usage and cost
  • Identify expected premium rates and effectively negotiate with providers to receive the best rate for your population