7550 North Palm Avenue, Suite 202 Fresno, California 93711, United States
Tel: (559) 862-4500 Fax: (559) 490-6211
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:
- Area surveys
- National trends
- Long range effect of benefits design, etc.
- 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