Large Group 101 and up

Large Group Services Include

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.

As Needed

Review Summary Plan Description, revise as necessary 

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

As Needed

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 pletation 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.

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

Renewal Period

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.