The following is a partial listing of services that may be provided to our clients and that are covered by our basic commission structure:

Plan Design

One of the most important aspects of our work is in this area.  Poorly designed medical plans can be very expensive for the company and generally not appreciated by the employees.  Our expertise in plan design has enabled most of our current clients to escape rate increases over the last three to four years without plan modifications.

Underwriting

Once a plan design has been agreed to by management, we underwrite the case so that we have an understanding of the risk involved and the premiums that will be requested by an insurance carrier or third party administrator.  Because we do our own in-house underwriting, we are better able to negotiate initial and renewal rates and fees with insurance carriers on new placements and renewals.

Reserve Calculations

In a fully insured plan, the insurance carrier calculates and holds a claims reserve.  In a self insured plan, minimum premium plan, or partially self insured plan,  the client typically holds the reserve.  The calculation of the reserve amount (IBNR) can greatly affect the overall cost of your plan.  Some carriers have been known to hold up to a six month claims reserve when the actual claims lag (the time lapse from the date a claim is incurred until the claim is paid) is 60 days or less.  If the reserve being held by the carrier is too great, in many instances, we are able to secure a release of the excess.

Preparation of Requests for Proposal

We prepare our request for proposals (RFP) with extensive details and submit these to appropriate carriers and third party administrators.  The more detailed the RFP, the less chance of having to compare dissimilar bids from competing sources.

Carrier Selection

A wide range of criteria are used to screen carriers and third party administrators.  Cost of services is only one of the selection criteria.  PPO network availability, reporting capability, utilization review procedures, and claims payment software are some of the additional items that are evaluated.  All pertinent data is then prepared in spreadsheet format and presented to the client with our recommendations. The client, of course, always has the final choice as to selection.

Contract Negotiation

Once the carrier or administrator has been selected, we work closely with the client and the carrier to assure that all desired plan provisions are included in the client's contract, including necessary filing with appropriate regulatory authorities when needed.

Communications

We feel strongly that a benefit plan cannot be beneficial if the employees are not properly informed as to the benefits being provided, the overall cost to the employer, and the appropriate use of the benefits.  We have found that keeping the employees informed and involved helps to reduce utilization in medical plans and increases participation in 401(k) and cafeteria plans.  We can prepare informative and useful handouts to explain your benefit plan to your employees and their dependents.  For some of our clients, we prepare regular paycheck stuffers that feature a single aspect of your plan.

Implementation

Any new benefit plan tends to have start up problems.  While we do all that we can to insure that problems are minimized, we do have support staff available to help you and your employees ease through the start up period.  We work hard to see that all ID cards, booklets, and PCS cards, if appropriate, are put into the hands of the employees in as short a time as possible.  To achieve this, time lines are constructed and agreed to by both client and carrier.  The carrier or the administrator is then held accountable for meeting the agreed to delivery times. 

Since problems will arise, we provide the employees with a toll free telephone number so that the employee or dependent can reach one of our staff for assistance.  We go to considerable additional effort to provide your employees and your staff with knowledgeable and timely assistance.

In many PPO plans, we find that employees would like to have their current personal physician contacted by the PPO network administrator about possible inclusion into the network.  We work with the employee and the carrier to make these contacts.  The employee is then advised as to the outcome of the contacts. 

ERISA Compliance Review

If not handled properly, this can be a confusing and expensive process.  We review all of a clients procedures to be sure that all filings are complete and current.  We find many clients have not been properly filing IRS Form 5500s or that Summary Plan Descriptions have not been properly filed with the Department of Labor.  The Department of Labor is currently auditing benefit plans in this area for compliance.

The Department of Labor performed a full audit of our office during the first part of 1991 and found no violations of ERISA compliance for any of our clients, past and present.

COBRA Compliance

COBRA is confusing and a potentially expensive piece of legislation for employers.  We assist you and your staff in preparation of COBRA letters, rates, and in follow-through with qualified beneficiaries.  We can assist in training your staff in the proper administration of COBRA.

Personal Claims Service

Because insurance terms and procedures are often like a foreign language to the average employee, there can be a constant flow of day-to-day claims questions and issues from your employees and their covered dependents.

PLANNING SERVICES allows companies to avoid spending their time solving these issues by providing a toll free telephone number to each of their employees.  Claims questions and problems are handled quickly and efficiently by our professional staff. Companies can choose to either be kept completely aware of any and all claims issues, or they can be completely removed from the process, should they so desire.

Hospital Audit Program

Through this program, employees are encouraged to keep track of all services received from a hospital stay.  This would include medications, use of operating rooms, recovery rooms, special supplies, etc.

When the employee checks out of the hospital, they compare their itemized bill with the Hospital Audit Worksheet.  If they find that they were charged for services or supplies that they cannot identify, they will then ask the hospital for proof that the service or supply was received.  If there are charges that should not be on the bill, and the hospital corrects the billing, the employer then rewards the employee with a check in the amount of 50% of the savings.

Occupational Injury Claims Management

Programs can be implemented which reduce the cost of on-the-job injuries through the management of all aspects of work related injuries and illness without compromising the quality of medical care for your employees.

The programs typically focus on both encouraging the employee to return to work on limited duty and on eliminating inappropriate care & over-utilization of medical services. 

Administration

We can prepare a complete administration manual for all of your benefit plans.  The manuals that we prepare illustrate step by step procedures for your personnel to follow from initial enrollment into each benefit plan through COBRA administration.  We include in each manual completed examples of all forms that must be prepared either by your benefits personnel or by your employees.

The following is a partial listing of additional services we can provide to our clients which are not covered by our basic commission structure:

COBRA Administration

We offer fully automated COBRA administration for several of our clients.  This service covers initial notification in conjunction with certificates of creditable coverage and monthly billing for those qualified beneficiaries electing COBRA continuation coverage. 

Wellness Programs

These programs encourage employees to take care of themselves and become wise consumers of the medical marketplace through monthly educational newsletters and payroll stuffers.  Employees are also provided with several preventive health measures and proven "home remedies" which keep them out of the doctor's office and reduce overall medical expenditures.

Benefit Communications Package

This program provides personalized employee statements which are designed to     educate your employees regarding the high cost of benefits provided, and improve overall employee attitudes toward their total compensation package. 

Employers use these statements to instill a better appreciation of the company's efforts and expenditures in relation to providing benefits to employees.  Additionally, the goal of the program is to effectively decrease employee turnover and to build employee morale.

Medical Claims Audits

Poor claim management practices can be costly.  While no claims payment operation will be 100% accurate, a claims audit can reduce benefit expenses by checking for overpayment and duplicate claim payments.  We can audit your carrier's or administrator's claim payment accuracy by examining a valid sample of the company's claims and determining the percentage of errors.