WE MAKE A DIFFERENCE
Claims Administration
Claims administration services are at the core of self-funding. Benveo is there every step of the way with our expertise and time-tested best practices and strategies. Our team designs the plan and writes the plan document. Our ACA experts make sure that the plan is compliant with federal healthcare mandates.
We create, print, and distribute ID cards and customized employee materials informing plan members about their benefits, our benefits website, a mobile app suite, and other beneficial resources. On an ongoing basis, we process claims and manage eligibility.
Our experienced customer service team provides answers and support to plan members. Employers receive monthly report packages with detailed benefit usage which assist in effective plan benefit design and monitoring. Our team will help clients understand where their healthcare dollars are going and why. Offer suggestions to control costs while maximizing benefits. This allows our clients more time to spend on their business and less time spent on benefits administration.
Greater Flexibility, Lower Fixed Costs, & Total Cost Transparency
More employers are discovering that self-funded plans are exempt from a number of ACA regulations that fully insured plans must meet.
■ Self-funded health plans are not subject to medical loss ratio requirements.
■ HHS - issued rules on “essential health benefits” do not apply to self-funded health plans.
■ Self-funded plans escape the health insurance industry fee, expected to be 2% - 2.5% of premium in 2014, 3% - 4% in future years.
These exemptions allow employers that choose self-funding to custom tailor their health benefits to the needs of their workforce and design plans that promote both wellness and responsible spending.
Plan Design Flexibility & Total Transparency Create the Potential for SAVINGS!
Two of the best features of self-funded plans are access to meaningful information on claims and costs, seldom available in a traditional, fully insured environment. When stop loss coverage is secured to limit the employer’s overall exposure for claim costs, both on a specific and aggregate basis, the plan retains the savings when claims are lower than expected.
Expert Administration
As a full-service Third Party Administration (TPA) firm, we handle employee enrollment, claims administration, and management information reporting. We also provide ID cards, plan booklets, call center support and easy, secure access to online and mobile tools - everything to make your plan operate smoothly.
Population Management
We use predictive modeling technology to weigh complex variables and identify the factors driving cost increases. Health risk assessments, disease management, and population management help improve the health of plan participants, often helping self-funded plans avoid costly future claims.
Not Just for Big Companies
While self-funding is more common among firms with groups of 100 or more, many smaller organizations are exploring it’s advantages. The only way to determine if self-funding is appropriate is to review a current employee census, premium rate history, or actual claims experience if the data is available.
