| Benefit Program Formulation |
Review of current plan design.
Review the current employee contributions and cost sharing structure.
Review of existing contract and agreement with current T.P.A.
Review all stop loss and administrative fees.
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| Strategic Planning |
Develop 3 to 5 year plan to mitigate rising health care costs.
Explore self-funded vs. fully insured or partially self-funded plans.
Review of consumer driven healthcare options (i.e., HSA, HRA).
Function as an advocate relative to health insurance mandates.
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| Program Renewal |
Obtain data to begin the Request for Proposal (RFP) process.
Prepare an RFP for submission to carriers.
Analyze managed care provider of service network match.
Review plan design and/or schedule of benefits.
Explore benefit carve out opportunities (i.e., drug, dental, vision).
Complete analysis of RFP submissions.
Negotiate with current vendors/carriers for most competitive pricing.
Negotiate rate renewal.
Make recommendation to client based on data and desired plan.
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| Program Implementation |
Work with Carrier(s) to implement program changes.
Ensure deductibles carryovers are credited correctly.
Screen enrollment applications and make sure loaded correctly.
Audit Carrier to ensure files/applications are loaded correctly.
Ongoing plan management services.
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| Enrollment Facilitation |
Conduct new employee enrollment meetings.
Collect enrollment changes, additions, and deletions.
Submit changes/enrollment applications to carriers.
Facilitate enrollment disposition with employer.
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| Employee Education |
Research in force plan for ways to effectively/efficiently utilize benefits.
Emphasize cost savings via purchasing prescription drugs.
Utilize local retailers that offer discount prescription drug programs.
Minimize health risk by adhering to Disease Management programs.
Explore and communicate free medical supplies programs.
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| Program Communication |
Employee group meetings - spouses included.
Periodic newsletter.
Email dedicated for questions/answers to ensure timely communication.
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| Wellness Centric |
Work within the community to offer Health Fairs.
Bring awareness to monthly health spotlights.
Highlight disease management programs within the plan that are free.
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| COBRA Administration |
Notification to Employees.
Facilitate communication between Employer and Employee.
Bill and collect monthly premiums.
Provide education and service for COBRA electors.
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| Flexible Spending Administration |
Facilitate initial set-up of accounts.
Handle reimbursement of claim activity.
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| Claim Resolution Assistance |
Work with health insurance carrier/providers to resolve claim issues.
Communicate claim resolution to requesting party.
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