Native Health Group
Tribally Self Funded Services Overview

Native Health Group (NHG) Native Health Group and its network of strategic partners take great pride in serving Native American Tribes, Native American Owned Businesses and Native American Organizations to manage risk, control costs, implement process improvements, and identify emerging opportunities for their changing and often complex employee benefits and tribal community health care needs.

Our Native American clients needs have evolved as the benefits and health care industry has changed. Because of this, we are continually looking for opportunities for improvement using the right combination of products, technology and service providers. Through the development of specialty services and strategic partner relationships NHG offers unique products and services for Native America Self Funded Programs to effectively manage their plans.

Native American Self Funded Employee and Tribal Members benefit plans are complex. Our services provide a complete approach to meet those needs. Our team delivers excellence in the continued management of your programs and initiatives.



NativeTPA is provides Third Party Administrator services for Native American Self Funded Programs. As a third party administrator of self-funded plans, the basis of our plan administration – claims processing, client & member management, and compliance – is our 360° Benefit Plan Management® approach. NativeTPA seamlessly integrated suite of plan management services called 360° Benefit Plan Management®, includes reimbursement accounts & COBRA administration, consumer-driven solutions, health & lifestyle management, technology and web tools, and data analysis & reporting. Each of these elements of 360° is inextricably linked and part of a continuous process geared to help reduce health care spending and increase member engagement and satisfaction.



NativeRx is a Pharmacy Benefit Management (PBM) solution for Native American Self Funded Programs. At NativeRx we put our clients' needs first by providing the most clinically appropriate medications at the lowest possible cost. Our business model embraces a Lowest Cost Philosophy and Culture of Service Excellence. Our pharmacy network provides access to all the major pharmaceutical outlets and can be customized to meet the access needs of each client.



NativeEAP/CAP provides Employee Assistance and Community Assistance Programs including and workplace and community support services. Using years of experience, we can design the right customized work/life, behavioral health, community counseling and training programs for your group. By listening to your needs we can deliver a high quality of service, prompt, professional response in times of crisis, provider availability and complete confidential services.



NativeRe provides stop loss coverage for Native American self-funded plans and their businesses, governmental entities and other enterprises. We also provide coverage for Native American tribes who provide benefits for their tribal members. Our approach at NativeRe is to design and offer benefit strategies with flexible solutions, superior customer service and hands-on involvement in underwriting, medical management, risk management, claims and administration.

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NativeTpa is a strategic alliance between Native Health Group, LLC (NHG) and Gilsbar, Inc. organized to offer third party administrative services for self-funded plans for the communities and business enterprises owned and operated by Native American organizations. Our 360° Benefit Plan Management® provides a powerful and fully-integrated system of continuous plan monitoring. Our goal is to be a constant resource for you, with a focus on providing innovative solutions for your benefit administration needs.

You should expect NativeTpa to deliver a total solution, one that lacks nothing in its service and capabilities. 360° is a continuous strategy, that when shared by a group of people with the same goals and interests, is at its best.

With over 45 years experience in plan administration, Gilsbar's solid core keeps the elements of 360° in balance. Our depth of expertise and administration experience allows us to identify unforeseen opportunities for your plan. Gilsbar's 360° works. We take our experience and integrate it with thought-leading solutions, actuarial analysis, reporting technology, web-based plan management tools, healthcare cost containment solutions, and consumer-directed plan structures to deliver an extraordinary approach to health plan management –– which will redefine the way the market evaluates third party administrators.

"Delivering solutions using effective plan management solutions"

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NativeRx is a strategic alliance between Native Heath Group, LLC (NHG) and PartnersRx Management, LLC (PRX) organized to offer Pharmacy Benefit Management (PBM) solutions for the self-funded plans for the communities and business enterprises owned and operated by Native American organizations.

At NativeRx we put our clients' needs first by providing the most clinically appropriate medications at the lowest possible cost. Our business model embraces two important concepts:

» Lowest Cost Philosophy
» A Culture of Service Excellence
Offering a lowest total cost philosophy focusing on drug mix is the single most important factor in containing drug plan costs.

Drug mix is by far a more powerful cost driver than all other factors combined.

The value of managing drug mix and reducing drug ingredient costs has resulted in an average savings of $6.00 per prescription for clients.

We are committed to continually providing the expertise, services and resources required to proactively support our clients. One size does not fit all, so we match service strategies that meet both client and member needs.

From plan implementation to the day-to-day management of prescription benefits, the very best resources and tools are available to ensure the highest levels of service satisfaction.

We are a full service pharmacy benefit management company that offers:

"Lowest Cost Philosophy - A Culture of Service Excellence"

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NativeEAP/CAP is a strategic alliance between Native Heath Group, LLC and Jorgensen Healthcare Associates, Inc. organized to offer Employee/Community Assistance Program solutions for services for the communities and business enterprises owned and operated by Native American organizations. We offer years of experience in designing the right customized work/life, behavioral health, community counseling and training programs for your group.

NativeEAP/CAP will deliver a Employee/Community Assistance Program that is designed specifically with respect to your employees or community's needs and culture.

Members of the employee or community benefit in three ways:

» Easy access to confidential, brief short-term EAP/CAP counseling can help resolve problems early, before they affect a person's family life or work life.

» CAP counselors and case managers help an individual or family identify and access the right care – within the community or anywhere in the country - when long term behavioral health care or treatment is needed.

» Community intervention and service linkages are strengthened and supported in the event of a large scale traumatic event.

NativeEAP/CAP Delivers:

» Dedicated, professional EAP/CAP Services - We are a private, professional service firm.

» 24-Hour Crisis Telephone Response - Toll-free Professional telephone crisis counseling 24 hours/day, seven days a week. Multi-lingual services provided.

» Confidential Assessment and Counseling Services – Licensed, professional counselors deliver quality assessment and brief, solution-focused therapy in safe, confidential office locations.

» Referral Support, Tracking and Follow-up – Our team assists with referrals for longer-term care based on client need, preferences, and coverages. Follow-up and ongoing support is provided.

» Critical Incident Debriefing and Crisis Response - Onsite assistance for community-wide emergencies, including community trauma debriefings and support services, and other crisis response needs.

» Online Support Services - Jorgensen Brooks Group website (www.jorgensenbrooks.com) provides e-mail access for counselor inquiries, information for members and families.

» Online Work/Life Service Program - Online information, education and support for eldercare, childcare, health & wellness resources. Extensive searchable childcare & eldercare database

» Awareness Materials - A variety of cards, posters and other print and online materials provided to maximize awareness of easy access to services and support.

» Quarterly and Annual Utilization Reports - Comprehensive, customized service reports provided.

» Satisfaction and Outcome Evaluation Services - Complete client satisfaction and effectiveness reports.

"Designed for your employees or community's needs and culture"

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NativeRe is a strategic alliance between NHG and Matrix Group Benefits, LLC (MGB) organized to offer medical stop loss insurance for self-funded plans for the communities and business enterprises owned and operated by Native American organizations. Our approach at NativeRe is to design and offer benefit strategies with flexible solutions, superior customer service and hands-on involvement in underwriting, medical management, risk management, claims and administration.

NativeRe offers unique stop loss insurance that protect employers with self-funded health plans from unexpected or catastrophic health claims, thus limiting the employer's risk while maintaining the advantages of self-funding. Our stop loss product limits employer liability to a specific dollar amount covered per life and overall liability for the whole group.

NHG has developed effective management approaches that facilitate the implementation of benefit plans and programs especially for community members, and separate benefit plans and programs for the business enterprises, and then combines them for the purposes of underwriting the medical stop loss program for NativeRe.

The management staffs of NHG and MGB have worked together for over ten years in managing benefit programs for Native American Tribal Programs. NHG professionals have a broad range of knowledge and under¬standing of the Indian health delivery system and the complexity of Indian Health Service and in Tribal programs. Standard benefits packages and health insurance pro¬grams are not designed to effectively work with the Indian health system, and require unique solutions. NHG focuses on developing the unique benefit solutions that meet the needs of Tribal programs.

"Effective management approach to meet your unique needs and support your success"

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