San Antonio, TX

Our approach is predicated on designing employee benefit programs that are both comprehensive and cost effective…maximizing the expected return on investment. Our process will include the following pillars: CONSULTING, BROKERAGE, COMPLIANCE, ADMINISTRATION

CONSULTING

• Develop a strategy to identify goals, assess plan cost, design service and support models, and wrap it all around timelines.
• Assessment of plan funding options: fully insured, partially self-funded, reference-based pricing and direct contracting.
• Assessment of pharmacy cost. Develop and implement PBM RFP’s to secure most competitive pricing and contract language.
• Consistently compare and contrast plan benefits and costs as it relates to peer benchmarking data.
• Assist with the budgeting process; employee/employer contribution strategies.
• Design, develop and produce customized open enrollment communication material to support HR communication initiatives.
• Conduct periodic utilization review and executive summary meetings to evaluate:
  – Budget
  – Cost Drivers
  – Network Access
  – Gaps in Care
  – Stop-Loss Tracking
  – Plan Trends
  – PBM Performance

BROKERAGE

• Establish risk profile to assist with managing budgeting process.
• Provide renewal plan and funding alternatives to analyze potential cost impact.
• Develop formal RFP process on an annual basis and manage the renewal process from start to finish…on time.
• Develop renewal analysis report, documenting plan recommendations, cost impact, and carrier service and support programs.
• Develop network access and network disruption reports to validate appropriate in-network penetration levels.
• Conduct finalist interviews to validate RFP responses, confirm alignment with HR related strategies, and facilitate client implementation process.

COMPLIANCE

• Health & Welfare Compliance Education
• Provide legislative and regulatory updates; covering federal, state and local compliance requirements.
• Assistance with DOL audits and similar federal and state regulatory inquiries.
• Evaluation and administration of COBRA, HIPAA, and FMLA plans and administration.
• ERISA compliance and disclosure support.
• PPACA impact analysis evaluation, support, and consulting.
• Periodic educational compliance and regulatory seminars and webinars.
• ERISA required document management; WRAP, SPD, POP, Form 5500.

ADMINISTRATION

• Dedicated account service team to integrate with client HR staff and manage overall benefits program.
• Proprietary cloud-based eligibility management platform to provide enrollment services (new hires, terms, and changes) throughout the course of a plan year.
• Dedicated claims specialist to triage with provider/carrier/employer to solve claim issues and questions for your employees.
• Assist with assessing wellness strategy goals and facilitate a discussion around wellness objectives.  Monitor the development of overall plan, tracking engagement and monitoring performance of wellness vendors.
• Devoted call center to work directly with your employees to help them successfully navigate the complicated healthcare delivery system.