Self-Insured Benefits Administration

Individual Employers with (35+) employees can find greater savings and control of their health care benefits by self‐insuring their health care plans. Some of the savings come from reduced administrative expenses associated with the plan as well as eliminating profits made by the Insurance Company. You can achieve flexibility and control by removing the cookie cutter options you are required to choose from by traditional insurance companies. You are in control of your future health care costs!

• Initial Set-Up of Employer Group Medical / Dental /Vision plan(s)
• Participant Enrollment, Eligibility and Account History
• Forms for Open Enrollment
• Assist in development of plan document and summary plan description
• Participant Communications
• Customer service (including toll-free access)
• Process/adjudicate claims in accordance with the plan document including the following services:
  • Coordination of benefits
  • Screening for reasonable and customary fees
  • Subrogation
  • Appeals
  • Claims adjudication
• Provide Standard Utilization Reporting and Analysis
• Stop Loss Management (submissions and collections), if applicable
• Financial Reporting and Reconciliation
• HIPAA Certificates of Coverage
• Financial Accounting
• Consolidated Billing for Service Providers
• Claims and Statistical Information to Employers and their Consultants
• Web Access for Employers and their Consultants regarding the Plan Financials
• Web Access for Participants regarding their Individual Health Care