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Employee Benefits Consulting
Our services include actuarial, underwriting, benefit modeling,
and claim predictability, coupled with account management services. Our
needs-based, time-tested, multi-step methodology is the cornerstone to every
client engagement.
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Goals & Objectives
We base the goals and objectives of our process on your
company's needs. Sample goals:
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Develop Request for Proposals (RFPs) for insured, stop loss, ASO, disease
management, PBMs, etc.
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Evaluate HSA plan designs
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Conduct market survey to review, evaluate and negotiate ancillary programs
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Determine appropriateness and need for voluntary benefit/product offering
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Evaluate comprehensive employee communications and develop new materials if
needed
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Create effective plan designs and provider arrangements to maximize utilization
within networks, while potentially lowering the overall benefit program costs.
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Plan Audit
We will perform an in-depth audit of costs (fixed and claims),
plan utilization, plan documents, contracts, communication materials and
general processes (if appropriate). Areas that will require immediate review
include:
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Analyze current and past claim experience
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Analyze benefit plan utilization
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Utilize predictive modeling tools for the purpose of identifying large claims
at their early stages.
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Evaluate network penetration, and effectiveness of contracts/discounts
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Evaluate the plan's utilization of your providers and facilities
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Compare actual costs to paid premiums, and to relevant benchmarks
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Compare plan design and contributions to relevant benchmarks
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Request for Proposal (RFP)
We will perform a thorough market analysis to validate its own
underwriting assumptions/projections and the renewals of each vendor. This
exercise could provide negotiating leverage with the current vendors for the
upcoming policy year. Specific areas that will be addressed include:
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Validate incumbent's renewal methodology
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Evaluate alternative programs and pricing offered by incumbent vendor
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Conduct a thorough analysis of similar alternative vendors (i.e. TPAs, stop
loss, PBM, disease management)
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Analysis
During this phase, we will carefully analyze the proposed
contracts and identify strengths and weaknesses that may exist. In addition,
our analysis will ensure the appropriate underwriting methodology was used for
pricing purposes. Our comprehensive marketing report will include:
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In-house underwriting to ensure proposal integrity
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Initiate underwriting negotiations
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Disclosure of all proposal contingencies
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Comprehensive financial analysis
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Provide benchmarking comparisons
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Recommendations
Based on the results of our marketing efforts, we will provide
unbiased recommendations. Our recommendations are based on overall proposal
strength and each carrier's ability to meet strict criteria set forth in the
RFP process. Once the field is narrowed, we determine which carrier or vendor
best meets your goals. Key items included during this phase are:
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Finalist selection
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On-site due diligence
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Performance guarantee (if appropriate)
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Financial negotiations
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Implementation strategy
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Implementation
Working closely with each vendor and your company, our experts will
coordinate the implementation, enrollment and communication of all programs, if
needed. This is critical phase that includes:
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Conduct implementation strategy meeting with all parties
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Develop employee communication materials
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Review enrollment materials
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Conduct employee educational meetings
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Proof and sign off on contracts
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Roll out your benefits website
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Account Management
Once the benefit programs are implemented, your account team will provide
ongoing services to your company. The account management involves resolving
day-to-day problems via a center and providing quarterly experience and
utilization reports for each program for forecasting purposes. Other key
services include:
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30 day review of implementation
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Update/change technology
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Monthly claims analysis - reported quarterly
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Quarterly strategy and service meetings
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Mid-year projections for upcoming plan year
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Daily access to dedicated account team
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Compliance guidance
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How do your current benefits plans stack up?
Request a free benchmarking report by
clicking here
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