Summary of Services

Medical / Pharmacy / Dental / Vision Planning

  • Evaluate and recommend self-funding and fully-insured options
  • Analyze benefit plan designs for short-term and long-term planning
  • Assist with employee contribution strategy
  • Review all plan documents and amendments
  • Analyze claim reports and provide financial analysis
  • Prepare disruption analysis of PPO networks
  • Research benefit options for project/part-time employees
  • Analyze FSA/HRA/HSA options

Compliance Assistance with State and Federal Mandates

  • PPACA (Health Care Reform) updates and conformance
  • Provide Wrap SPD & Plan Document
  • Provide assistance with annual 5500 filing
  • Provide HIPAA Policy & Procedures manual
  • Legislative briefs on benefit law changes
  • Provide clients with pertinent benefit articles, updates and emerging industry trends
  • Recommendation on plan provisions to comply with benefit law changes
  • Provide on-line legislative guides (HIPAA, COBRA, FMLA, Section 125, etc.)

Long Range Strategic Planning

  • Initial strategic plan development
  • Evaluate overall objectives and measure goals
  • Annual and ad hoc strategic planning update, including plan design consultation
  • Review and implement cost containment procedures, where applicable

Health and Wellness Initiatives

  • Assist with claims analysis to identify health improvement opportunities
  • Develop a Health Risk Assessment process
  • Health Coaching, Disease Management and Patient Advocacy Programs
  • Smoking Cessation and Weight Loss strategies
  • Enhance Employee Assistance Program utilization

Medical/Pharmacy Data Analysis

  • Benchmarking plan utilization
  • PPO provider network evaluation – PPO analysis
  • Direct provider contracting and network development for self-funded groups
  • Medical and pharmacy plan design modeling
  • Plan design benchmarking to peer employers
  • Review chronic illness/disease management options

“VIP” Customer Service Support

  • Act as a resource for difficult claim situations
  • Coordinate care and referrals for unique and “VIP” patient situations
  • Provide quick turnaround time for employee benefit related issues
  • Assist in resolving billing issues with employees and health care providers

Communication Strategies

  • Assist with creation and maintenance of employee benefits website and enrollment portal
  • Healthcare and related educational employee communication pieces
  • Assist with employee benefits surveys and/or focus groups

Vendor Management and Negotiations

  • RFP/RFI development and management
  • Develop and monitor performance guarantees for each vendor
  • Continuous monitoring for potentially favorable financial arrangements
  • Pre-renewal meeting with client to discuss renewal strategy
  • Marketing to carriers and service providers
  • Manage implementation and data exchanges with carrier(s)

Other Benefit Initiatives

  • Assist with outsourcing benefits administration
  • Development of on-site healthcare and wellness services.
  • Analyze and recommend life and disability options
  • Create and communicate employee paid voluntary benefits programs
  • Review long term care, group home/auto, pet insurance and other non-traditional benefits.

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