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COMPANY BACKGROUND |
H E R E A R E J U S T A F E W O F T H E W AY S W E C U R R E N T LY H E L P O U R C L I E N T S :
Open Enrollment Communication & Coordination Eligibility Management & Transfer Life Event/Status Changes Act as Liaison Between Employers & Insurers Assist with Claim Resolution
Our teams focus is on addressing the full scope of Group Health Insurance needs across the following areas:
Initial plan design review Our process begins with an assessment of the design of your current plan benefits, costs, and appropriate given employee participant profile. Includes benchmarking across carriers as well as plans within carriers. Regardless of whether an immediate plan design change is made, this helps provide needed insights at the next renewal. Renewal Management 90 to 120 days prior to renewal our team will initiate the renewal process. We will collect needed changes to employee participation (if any), out of network usage, and other such consumption considerations to begin negotiating directly with the carriers. Consideration will be given to the optimal plan design within and across carriers Employee Assistance Program Within 60 days of the broker of record change we will establish a 24/7 nurse hotline to service the groups. Our hotline partner will be provided needed information on the group contract and participation. Scope of services for the 24/7 nurse line includes: any questions or concerns regarding emergency or normal medical questions. Any questions regarding prescriptions. Information about doctors that would allow an individual to choose an in network doctor and avoid paying out of pocket.
Communications Web portal to allow easy access for employers and employees to easily communicate and see Group Health insurance and other company benefits. The Web Portal will have all the contact information of the members of our team to maintain an easy contact relationship. This Web Portal will also have updated information on Health Care reform and dietary and nutrition articles. Business updates and forms necessary to participate in the gym reimbursement
Claims Management If there is a claim issue we support participants to navigate the dispute process directly with the carriers. We fight on behalf of our groups and clients to make sure the coding is correct, that the reimbursement is aligned with the right schedule and that the insurance company will pay for the procedures they are suppose to pay for. We have a team of individuals experienced and knowledgeable about claim coding and reimbursement who act as a resource for all of our groups. Seasonal Flu Shots Every year during flu season we will conduct a health expo lunch-in that consists of our team bringing lunch in for the employees and having a certified registered nurse provide all the employees of the company with free flu shots. We bring the flu shots to the employees to convenience them. Monthly/Quarterly Communication Seminars With our dedication to service, we will meet with your group on a monthly/quarterly basis reviewing various topics. This process will build a strong relationship while giving education to your employees on numerous topics in the industry. Onsite Employee Enrollment During the renewal enrollment period or when a new employee is hired, we will have one of our qualified representatives onsite at your business reviewing each individual detail of the current benefits being offered. This will eliminate any work internally for your organization. Onsite Human Resource Training Within 60 days of the broker of record change, we will provide an outside human resources consultant to help train your staff and make the day to day operations more efficient for your organization. Employee Contests Throughout the year, our team implements certain contests that give the employees of your organization incentives to stay healthy.
The process our team will utilize to conduct an initial design review of your plan
1.
Our team will profile and map the various Insurance benefit programs. Key activities include:
Profiling We will map the various plans to create a baseline. We will also look for similarities and differences among the plans, which can later be correlated to member feedback. Cost Analysis We will analyze and segment all elements in Insurance benefit expenses. Included will be legally required costs, compensatory costs, supplemental costs, and administrative costs. This will establish the current cost baseline from which to measure our program design and provider sourcing results
2.
From an administrative perspective switching brokers is a simple broker of record change form directed to the carrier. Once executed, our team will complete an introductory seminar to introduce them to the value added services. At any time if there is a change made to plan design (either at renewal or off renewal); our team will be instrumental in communicating the plan design changes and benefits to you and your employees.
3.
We secure and otherwise facilitate the purchase of insurance coverage for policyholder clients from a variety of insurance carriers and are paid directly by the carriers. Our fees are embedded in existing carrier premiums.
4.
We have assembled a very strong and experienced team with deep subject matter expertise to support this important initiative. Using a best-of-breed approach we bring a team with cross-functional industry and management consulting experience.
MEDICARE
Once an employee reaches age 65 we will provide a detailed analysis of the current plan offered through the company vs. the various supplemental plans offered through Medicare (which is more cost effective)
BUSINESS
FINANCIAL
PLANNING
STRATEGY IMPLEMENTATION
GROUP INSURANCE
RETIREMENT PLANS
Health Insurance Long-Term Care Insurance Disability Income Insurance Life Insurance Employee Financial Planning Educational Seminars
FINANCIAL PLANNING6
EXECUTIVE BENEFITS Bonus Plans Deferred Compensation Plans Split-Dollar Plans Group Carve Out
BROKER
MANAGEMENT
WEBPORTAL
In one sentenceits the power of staying connected. Utilizing the latest technology, HR Total Access integrates the major human resource functions ranging from compliance and payroll to employee benefits
ERISA &
R E G U L AT O RY
COMPLIANCE
Maintains all required records for the mandated amount of time. Provides instruction regarding required on-site record keeping. Completes all required forms accurately and promptly. Offers the flexibility to maintain separate ERISA Plans or bundle different benefits into a single Plan. Prepares and designs the required Plan Document and the Summary Plan Description. Provides guidelines for disclosure of required information to employees. Prepares all applicable forms and schedules.
Assists in obtaining necessary information from insurance carriers to prepare required forms & filings.
Prepares the Summary of Materials Modification (SMM) & Summary Annual Report (SAR) if required. Assists with resolution in the event that any employee benefits plans are reviewed by the Dept. of Labor. Provides access to experienced employee benefits professionals. Provides an Audit Guarantee, toll-free Customer Service, and 35+ years of experience in employee benefits administration.
Provides Healthcare Reform Notices required under PPACA and PHSA mandates.
COBRA
COBRA (Consolidated Omnibus Budget Reconciliation Act) requires an extension of group health benefits to employees and their families who lose their health benefits because they have experienced specific qualifying events. COBRA Administration offers valuable services for employers:
Protects your interests: assumes liability for all required administrative procedures and regulations. Makes it easy to monitor your COBRA activities: provides easy-to-understand account reports. Collects COBRA premiums: manages all aspects of the collection of COBRA premium payments.
Service promptly takes care of the necessary communications, notices, forms, and recordkeeping
Administration that provides for the collection of premium payments connected with COBRA
In all, it's a security blanket that ensures a health plans compliance with complex federal regulations
HR 360
HR
360
The One Reliable Source for HR Forms, Information and Online Tools, HR360 is the premier online HR library that provides a comprehensive 360 degree view of human resource and benefits laws both on a federal and state level. HR360 also provides a
Whether you have 5 employees or 500we provide the guidelines that will help you comply with the laws written in plain English so its easy to understand. Our dynamic online HR
library provides:
Compliance steps that clearly explain how to comply with the law and avoid penalties or potential employee lawsuits
Thousands of pages of HR and benefits content Fast, efficient online HR tools for developing job descriptions and salary benchmarking Over 500 downloadable forms, posters and model notices Specific dates and deadlines that many laws require Give your clients a big broker impression
MD Direct 24/7
MD
DIRECT
24/7
MDDirect247 is a nationwide network of medical physicians who review your medical record collected by MDDirect247 registered nurses 24/7. MDDirect247 physicians
ANCILLARY PRODUCTS |
D EN TA L
About 35,000 Americans are diagnosed with some forms of oral cancer
Insurance is expected to cover only about 48 percent of all dental expenditures by 2013, predicts the U.S. Centers for Medicare and Medicaid Services. Eight percent ($10 billion) of all dental expenditures will be covered by government aid. The other 44 percent will be out-of-pocket expenses.
e a c h ye a r, a n d o f
those, approximately 7,500 will die from the condition. Most
ANCILLARY PRODUCTS |
VISION
While 81% of Americans wear eyeglasses or contact lenses, a huge percentage of that population is not seeing as well as they
Comprehensive eye exams can detect serious visual problems, symptoms of diseases like diabetes, hypertension, multiple sclerosis, brain tumors, osteoporosis and rheumatoid arthritis, and health problems like liver and kidney problems.
Getting routine examinations can help the eye doctor detect any problems early and help you get the proper treatment. For instance, conditions like Keratoconus, Glaucoma, and Cataracts can cause severe vision loss or blindness if left untreated. Additionally conditions like acute glaucoma is a medical emergency and requires
immediate treatment.
1/ Had Your Eyes Checked Lately?, Atlanta Journal Constitution, 6 de junio de 2009
ANCILLARY PRODUCTS |
WORKSITE INSURANCE
Simplified issue or no underwriting Dependent and spouse coverage (except for Disability Income) Premium rates based on the individuals age or a group composite Critical Illness coverage for dependent children at no additional cost Guaranteed issue amounts available at all group sizes when participation requirements are met and no evidence of insurability is required Policy can be issued to a minimum of 10 covered lives Eligibility requirement of only 15 hours worked per week
DISABILITY INCOME:
The plan provides income replacement benefits based on the total wages of the insured employee for a covered disability resulting from an accident or illness. Both total and partial disability benefits are available. For injuries and illnesses related to a pre-existing condition such as pregnancy, an optional benefit can be added.
ACCIDENT:
Unique and affordable, an Accident product pays benefits for injuries ranging from dislocation to dismemberment, coma, concussion, fractures, lacerations and more. Accidental death, catastrophic accident and paralysis benefits also are included and pay up to $200,000.
ANCILLARY PRODUCTS |
GROUP LIFE
Access to many of the nations Highest Rated, Domestic, Life and Term Life Insurance companies. Most of the suites of Term Life products include a matching Accidental Death and Dismemberment (AD&D) benefit to both the insured employee and covered dependents.
Most plans feature:
Coverage from $5,000 to $250,000 in $1,000 increments Coverage is guaranteed issue based on group size, up to a maximum of $100,000*
The AD&D benefit includes a seat belt benefit that pays $50,000 to the beneficiary should the
covered person die as a result of an automobile accident while wearing a seat belt.
ANCILLARY PRODUCTS |
LONG-TERM CARE
Two out of Five Americans will eventually need long-term care at some point in their lives and having long-term-care insurance alleviates the pressure on a spouse or family member to be the primary caregiver. Neither Health nor Disability Insurance covers long-term care, leaving Long-Term-Care Insurance as the only option besides paying out-of-pocket.
There are typically tax incentives for those who buy long-term-care insurance. No taxes are owed on benefits paid out. In New York, tax filers
are eligible for a tax credit equal to 20% of their annual premium.