Employee Benefits Consulting Services

Goals & Objectives

Benefitdecisions' bases the goals and objectives of our process on your company's needs. Sample goals:

• Develop Request for Proposals (RFPs) for insured, stop loss, ASO, disease management, PBMs, etc.
• Evaluate HSA plan designs
• Conduct market survey to review, evaluate and negotiate ancillary programs
• Determine appropriateness and need for voluntary benefit/product offering
• Evaluate comprehensive employee communications and develop new materials if needed
• Create effective plan designs and provider arrangements to maximize utilization within networks, while potentially lowering the overall benefit program costs.

Plan Audit

Benefitdecisions 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:

• Analyze current and past claim experience
• Analyze benefit plan utilization
• Utilize predictive modeling tools for the purpose of identifying large claims at their early stages.
• Evaluate network penetration, and effectiveness of contracts/discounts
• Evaluate the plan's utilization of your providers and facilities
• Compare actual costs to paid premiums, and to relevant benchmarks
• Compare plan design and contributions to relevant benchmarks

Request for Proposal (RFP)

Benefitdecisions 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:

• Validate incumbent's renewal methodology
• Evaluate alternative programs and pricing offered by incumbent vendor
• Conduct a thorough analysis of similar alternative vendors (i.e. TPAs, stop loss, PBM, disease management)

Analysis

During this phase, Benefitdecisions 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:

• In-house underwriting to ensure proposal integrity
• Initiate underwriting negotiations
• Disclosure of all proposal contingencies
• Comprehensive financial analysis
• Provide benchmarking comparisons

Recommendations

Based on the results of our marketing efforts, Benefitdecisions 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:

• Finalist selection
• On-site due diligence
• Performance guarantee (if appropriate)
• Financial negotiations
• Implementation strategy

Implementation

Working closely with each vendor and your company, Benefitdecisions will coordinate the implementation, enrollment and communication of all programs, if needed. This is critical phase that includes:

• Conduct implementation strategy meeting with all parties
• Develop employee communication materials
• Review enrollment materials
• Conduct employee educational meetings
• Proof and sign off on contracts
• Roll out your benefits website

Account Management

Once the benefit programs are implemented, Benefitdecisions 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:

• 30 day review of implementation
• Update/change technology
• Monthly claims analysis - reported quarterly
• Quarterly strategy and service meetings
• Mid-year projections for upcoming plan year
• Daily access to dedicated account team
• Compliance guidance

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