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Employee Benefits

Our approach is predicated on designing employee benefit programs that are both comprehensive and cost effective…maximizing the expected return on investment. Our process will include the following pillars: CONSULTING, BROKERAGE, COMPLIANCE, ADMINISTRATION

CONSULTING

  • Develop a strategy to identify goals, assess plan cost, design service and support models, and wrap it all around timelines.
  • Assessment of plan funding options: fully insured, partially self-funded, reference-based pricing and direct contracting.
  • Assessment of pharmacy cost. Develop and implement PBM RFP’s to secure most competitive pricing and contract language.
  • Consistently compare and contrast plan benefits and costs as it relates to peer benchmarking data.
  • Assist with the budgeting process; employee/employer contribution strategies.
  • Design, develop and produce customized open enrollment communication material to support HR communication initiatives.
  • Conduct periodic utilization review and executive summary meetings to evaluate:
    – Budget
    – Cost Drivers
    – Network Access
    – Gaps in Care
    – Stop-Loss Tracking
    – Plan Trends
    – PBM Performance

BROKERAGE

  • Establish risk profile to assist with managing budgeting process.
  • Provide renewal plan and funding alternatives to analyze potential cost impact.
  • Develop formal RFP process on an annual basis and manage the renewal process from start to finish…on time.
  • Develop renewal analysis report, documenting plan recommendations, cost impact, and carrier service and support programs.
  • Develop network access and network disruption reports to validate appropriate in-network penetration levels.
  • Conduct finalist interviews to validate RFP responses, confirm alignment with HR related strategies, and facilitate client implementation process.

COMPLIANCE

  • Health & Welfare Compliance Education
  • Provide legislative and regulatory updates; covering federal, state and local compliance requirements.
  • Assistance with DOL audits and similar federal and state regulatory inquiries.
  • Evaluation and administration of COBRA, HIPAA, and FMLA plans and administration.
  • ERISA compliance and disclosure support.
  • PPACA impact analysis evaluation, support, and consulting.
  • Periodic educational compliance and regulatory seminars and webinars.
  • ERISA required document management; WRAP, SPD, POP, Form 5500.

ADMINISTRATION

  • Dedicated account service team to integrate with client HR staff and manage overall benefits program.
  • Proprietary cloud-based eligibility management platform to provide enrollment services (new hires, terms, and changes) throughout the course of a plan year.
  • Dedicated claims specialist to triage with provider/carrier/employer to solve claim issues and questions for your employees.
  • Assist with assessing wellness strategy goals and facilitate a discussion around wellness objectives.  Monitor the development of overall plan, tracking engagement and monitoring performance of wellness vendors.
  • Devoted call center to work directly with your employees to help them successfully navigate the complicated healthcare delivery system.