Audit - Benefits Program - An independent review of existing employee benefit programs. Broad topics considered in the study are Funding, Contractual Provisions, Premium History, Claims History, Competitive Position and Loss Control. Our work product includes a comprehensive written report detailing our findings and recommendations. We will also help to implement our recommendations.

Audit - Claims Practices - An investigation and assessment of claims management practices, including reporting procedures, accuracy of benefits pair, eligibility, coding and other criteria for both insured and/or self-insured programs.

Cafeteria Plans - Assistance in examining the potential for an Internal Revenue Code 125 Cafeteria Plan (flexible benefits program) by analyzing advantages and disadvantages as they relate to a client’s specific needs. When appropriate, we design, implement, and communicate such a program, which could range from a simple premium-only plan (POP) to medical and dependent care flexible spending accounts (FSAs), to a complex program of benefits; e.g., core-plus or modular plans.

Cost Containment - Assistance in controlling the upward spiral of employee group medical costs to achieve demonstrable savings. Cost containment services include negotiation of exclusive provider organization (EPO) contracts, analysis of network adequacy, identification of the most cost efficient delivery systems, recommendation of funding methods, design of prototype group plans, and communication of the necessity of cost containment to employees.

Executive Life Insurance - Evaluation and analysis of complex risk elements found in life insurance policies, buy-sell agreements, key man coverages, deferred compensation, split dollar programs, executive carve-out plans, and interest-sensitive and survivorship insurance.

Executive Overview - A direction finder designed for clients who may be uncertain about their consulting needs and wish a preliminary overview of their existing or proposed program before proceeding with a material change or commissioning a major consulting assignment.

Expert Witness - Interpretation of insurance coverage and explanation of industry customs and practices is often required in arbitration and court proceedings. Our resources include senior staff with JD degrees, an extensive insurance and insurance-law library, and Westlaw, an on-line legal research service.

Medical Cost Analysis - Analysis and interpretation of group medical claims data, translating it into information that is useful for long-term benefits and human-resource planning. The results enable clients to develop benefits plans, diagnostics, wellness programs, and employee assistance programs (EAPs) that are responsive to the needs of an organization, yet cost effective.

Negotiations With Health Care Providers - Assist in formulating favorable financial arrangements directly with hospitals and physicians. Direct purchase provider agreements are increasingly popular as a way to ensure the most favorable contractual terms and conditions for medical managed care.

Performance Standards and Guarantees - Development of strict performance standards and guarantees of accountability for insurers and plan administrators. These standards describe precisely the services and products expected, delineate responsibilities and measure performance quantitatively. Failure to perform to defined standards results in monetary penalties.

Renewal Analysis - Evaluation of employee benefits group plan renewals, with emphasis on cost containment and funding levels, breaks through the technical jargon used by insurers or administrators to obtain the lowest possible costs. Plan design and/or funding method changes are addressed to produce additional savings.

Retainer Services - This can be either a defined schedule of continuous services or an ad hoc arrangement in which we respond to specific requests. One frequently requested retainer service explains legislative changes and their effects on existing employee benefit programs.

Second Opinion - For clients who, on occasion, need an independent view on a specific issue and simply want to access our experience and resources on a limited use. Second opinions can serve to reinforce a decision already made or to identify issues and raise questions that require further consideration.

Special Studies - With respect to specific issues, problems or proposed changes recognized by the client, special studies are performed to identify practical solutions. Examples include funding alternatives, health-care cost containment procedures, consortium development, and multiple-option plan designs.

Specifications and Marketing - To facilitate an orderly request for comparisons between competitive proposals from insurers and service vendors, we develop written specifications. We will design specifications, identify and control markets, conduct pre-proposal conferences, analyze proposals, negotiate with proposers, formulate recommendations, present results to management, and assist with the installation of new programs.

Reach us at (727) 577-2780