Schedule of Services

Vendor Analysis/Recommendations

Third Party Administrator (TPA)/ASO Provider
PPO Network(s)
Precertification/Large Case Management
Prescription Drug Manager (PBM)
Insurance and/or Reinsurance Carrier
Spending Account Vendor(s) – HSA/HRA/FSA
Wellness/Health Risk Management

Benefit Plan Design

Analysis
Recommendations
Evaluate Readiness for Change

Plan Eligibility (employee and Dependent)

Assessment
Recommendations

Insurance Premium and Spending Account Contributions

Assessment
Recommendations

Reinsurance Contract Review (If Partially Self-Funding)

Assessment
Recommendations

Reports

Assist in Determining Necessity of Appropriate Reports
Provide reports
Analysis of Data

Evaluate Proposals

New Business
Renewal

Market the Plan

Bid Requests
Review Bids
Negotiate Rates
Recommendations

Plan Performance Reviews

Minimum of Semi-Annual

Wellness / Health Risk Assessments

Collect / Review Data
Educate Employees
Provide Aggregate Data to Employee and Organization
Program(s) Evaluation and Implementation
Recommendations

Renewal

Evaluate and Substantiate Current Carrier Offer
Bid Requests
Review Bids
Negotiate Rates
Recommendations

Eligibility, Claims and Plan Administration Interface (Employer and Employee)

Enrollments
Plan Overviews
Q & A

Employee Education and Engagement

Group Sessions
Individual Sessions
Healthcare Overview
Overview of Client’s Plan Benefits
Plan Cost Saving Recommendations

Administrative and Compliance Resource

COBRA / HIPAA / FMLA / ADA
FSA / HSA / HRA
ERISA
PPACA
Other Related Federal and State Laws, Rules, and Regulations