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.