With more than 30 years’ experience working with Funds and Trusts, we can design, implement, and administer health and welfare plans that maximize member benefits and minimize your costs. We also streamline the process of member eligibility and enrollment to quickly onboard members and manage ongoing eligibility.
Since no two clients are alike, we will work with you to design and customize health and welfare plans that suit your population and budget. You can determine copay amounts, deductibles, covered services, services requiring prior authorization, coverage levels for out-of-network services, and more.
Whichever plan you choose – PPO plans, consumer-driven health plans (CDHP) such as HRAs and HSAs, or other plan types – you’ll be supported by an account management team that is committed to the success of your health plans. We offer extensive provider networks for convenient member access, in your region or nationwide.
Save with lower administrative fees on our self funded health plan, where you pay only for member claims and not a monthly premium that goes up every year. You gain full transparency into your claims data and exemption from state and premium taxes.
We work with every client to determine optimum funding. Thanks to our broad experience as a health plan administrator and our extensive, national provider networks, we can administer custom benefits that meet the specific needs of your group. These include:
Through plan design and care coordination services, we can guide your members to seek care from your preferred providers. Our robust technology platform supports flexible claims management, including tiering.
Our claims management system supports an array of pricing models, including reference-based pricing, to help you contain costs. You can choose to set spending limits on high-cost procedures and negotiate value-based pricing with hospitals and outpatient facilities based on Medicare rates or a custom fee schedule.
Pay a fixed monthly amount, based on previous claims history. You’ll receive a refund if the annual claims experience is lower than the maximum liability.
Our in-house clinical team provides utilization management, case management, cost containment, and other medical management services to oversee the quality and cost of care. By layering medical management services over your existing provider network, we can:
COBRA requirements are so complicated, it takes an expert to manage your cases effectively and ensure compliance. We’ll manage eligibility, record, deposit, reconcile COBRA and retiree contributions, and handle all communications with your COBRA members.
Communicate effectively with members, replacing costly mailings
View and manage eligibility and enrollment
Review claims data and track medical spend
Monitor employer hour uploads and premium payments
Receive actionable, real-time reporting on key demographic, utilization, and trend metrics to help control costs
The mobile app gives members round-the-clock access to the same medical and health plan information that they can view on the Member portal:
Provide superior customer service using our locally based, on-shore, multilingual team of customer service experts. With a 99% first call resolution rate and less than 30 seconds average speed to answer, we have never missed a performance guarantee – ever.
Members can contact our concierge team by phone or email, or online using click-to-call, click-to-chat, or request a callback.