Large Group Benefits Management

Self-Funded Benefits Management

A Benefits-Online benefit Consultant will assist in developing and maintaining an employee health and welfare benefit plan that is balanced between cost and coverage. These services are performed on an:


PLAN MANAGEMENT


  • Monthly

Analyze existing plan design


  • Quarterly

Advise of any desirable shift in emphasis in benefits that arise as medical care, delivery systems and patterns of practice change. 


  • Quarterly/Monthly

Monitoring utilization trends, calculate benefit costs by line, compare to industry figures, and recommend changes in benefits and cost implication.


  • Quarterly/Monthly

Advise on any desirable changes in eligibility rules and periodically determine whether eligibility rules are appropriate as needed. 


PLAN ADMINISTRATION


Assess and monitor fund assets and income to meet the obligations of the plan. 


  • Weekly

Evaluate claims experience 


  • Monthly

Prepare and evaluate claims lag studies and incurred claims liability

  • Monthly


Project inflation and utilization trends, advise on reserve policies and reserve levels for each benefit

  • Monthly

Prepare reports of plan funding status and plan experience

ANALYSIS OF RATE RENEWAL ACTION  

  • 90 days Prior to Renewal  

Determine appropriate levels of risk to either retain or layoff (self -fund vs. insured risk, stop loss policy). Calculate cost of specific benefits that may be considered.

  • As Needed monitor plan experience and design with:

  1. Area surveys
  2. National trends
  3. Long range effect of benefits design, etc.
  4. Similar organizations (type and size)

  • Monthly

Coordinate procedures for handling claims disputes

  • Daily

Advise on recommended guidelines for claims which are appealed

  • Daily

Advise on Usual and Customary guidelines and procedures

  • As Needed

Review large claims and recommend action as appropriate, advise on plan interpretation and administration.

  • As Needed

Review Summary Plan Description, revise as necessary

Prepare all announcements of plan changes of either benefits or eligibility. Prepare Summary Annual Report