How It Works
The Voting Process
With Adjudica, plan sponsor can choose to allow the members of the group plan to have a democratic say in some of the plan design decisions. Adjudica believes that once plan members understand how much the different categories of care, devices and experimental treatments actually cost them each month, they will want to participate in making those decisions and get the best value for their health care dollar. Adjudica's Group Self-Management platform provides the information needed to reach a decision, a forum for discussion of the options and a voting process to record the group's decisions.
One Vote Per Person Covered
Every person in the plan gets one vote, even children. The mother, father or guardian casts the child's vote. Voting is done through the GSM platform's secure online website or by telephone.
Examples of What Might Get Voted On:
- Increases or decreases in the premiums to group members.
- Changes in deductibles or co-pays.
- Additions or subtractions to the "Always Covered" list.
- Increases or decreases in elective care budgets.
- Changes in the voting percentages needed for different approvals.
- Reallocation of spending among different spending budgets.
- Increase in premium to make up for shortage.
- Allocation of overage either as reduction in monthly premium or added benefit in subsequent periods.
Someone Can Vote for You
As with any democracy, if you do not want to vote, you do not have to vote. If you dont' want to vote, but want your voice heard, you may use a proxy system to cast your vote via another member. For example, if you know that a co-worker understands medicine, you may assign that co-worker the right to cast your vote. The proxy system allows people to choose representatives to participate in the decision making process for them.
Making proposals to change the plan
Adjudica's Group Self-Management platform provides a filter to limit the number of proposed plan changes members can vote on. Only proposed changes that have broad support are included in the annual vote. If a member has an idea for a change, that idea must accumulate general support or it will not be brought up for vote. A section of the online forums allow group members to post suggestions for changes. Other group members have the ability to sign on to support putting the proposed change up for vote. If enough of the group members sign on to support the proposed change, it is formally reviewed by the plan administrator. If it continues to gather support and reaches a second threshold, the idea becomes a ballot initiative that can be voted on by the membership.