About Tribal Services

SIP Tribal Services

The Indian Health Service (‘IHS’), an agency within the Department of Health and Human Services,  oversees and is responsible for providing federal health services to members of federally recognized tribes including American Indians and Alaska Natives (hereafter referred to as “tribal members”).

Many tribal members receive medical care directly from tribal clinics and health facilities near their place of residence.  However, some medical services are not available through tribal clinics. A program called Contract Health Services (“CHS”), administered by IHS, was instituted to supplement and complement other health care resources available to eligible Indian people, including care available from tribal clinics and other tribal health facilities. CHS funds are available for use in situations where: (1) no IHS direct care facility exists,(2) the direct care element is incapable of providing the required emergency and/or specialty care, (3) the direct care element has an overflow of medical care workload, and (4) supplementation of alternate resources (i.e., Medicare, private insurance) is required to provide comprehensive care to eligible Indian people.  

The TPA

Self Insured Plans LLC (SIP) is headquartered in Naples, Florida, with its’ National Service Center in Naperville, Illinois and a sales office in Honolulu, HI.  

SIP is home to dedicated employees who focus every day on delivering new and innovative products and world class service to our clients.  With more than 45 years experience in benefit management and administration, state-of-the-art technology and industry leading customer service, SIP consistently delivers employee friendly and cost efficient solutions to your most challenging benefit issues.

Additional SIP Services

Population Health Management and Disease Management

  • Chronic Disease Management - We carefully track the 27 chronic diseases that represent more than 95% of total plan expenditures.  The program’s goal is to see that every participant:
    • Receives the right treatment,
    • At the right time,
    • From the right physician,
    • Who is doing the right thing.
    Nurses will reach out to any participant who is not receiving one or more of these key elements in an effort to “steer: them in the right direction and to receive the required care.  Some plan designs encourage voluntary participation, but most plans now require a participant to participate in the disease management program or pay a higher contribution or higher deductibles, etc.
  • Physician Profiling - Identification of high quality, cost effective providers is essential in order to control plan healthcare costs.  It is also critical for employers to steer their members to providers who have proven to follow evidence based medicine guidelines in a cost effective manner. A physician who does not follow these guidelines is on average 40% more costly.  An employer that uses 15% of these physicians will have their costs unnecessarily increased by as much as 10%.
  • Predictive Modeling - We know that we can provide 100% discounts on claims that are prevented. SIP uses a powerful tool to identify potential high risk claimants and then engages our nurses to work with the patient to guarantee that they participate in all of our care management programs.

The ability to leverage Medicare pricing for tribal medical services under CHS provides significant savings to Tribal Health programs and allows tribal health organizations to extend the “buying” power of their health dollar. As can be seen from this summary of the legislation, there are requirements that must be met before MLR pricing is applicable, but the requirements are reasonable and easy to administer for most Tribal entities, especially with the assistance of SIP.

To find out more about Self Insured Plans Tribal Services, or to request a free quote, please contact us.

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