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How to Buy TPA Services

Is Self-Funding Right for You?

Health care costs rank among the top concerns of U.S. Employers. How to design and finance a quality, yet affordable benefit plan is a question on every employer and corporate executive’s mind.

Self-funding benefits for employees have become a growing trend since the late 1990’s. It is estimated that over 57% of all health plans in the U.S. are self-funded. So what is it that draws employers away from being fully insured to self-funding instead?

The following is a sampling of the advantages you receive by choosing a Self-funded Plan:

  1. More flexibility in plan design: As insurance carriers work to meet Medical Loss Ratio (MLR) requirements and try to cut administration cost, they end up offering fewer plan designs, resulting in limited choices for employers. Self-funding allows the employer to design benefit plans that are tailored to the needs of their employees, allowing for a custom plan that aligns with unique benefit budgets.
  2. Competitive options: The fully insured arena is dominated by just a handful of companies. With self-funding you benefit from a broader market of stop-loss companies to maintain a competitive marketplace.
  3. View and manage your claims information: With a fully insured carrier, your access to claims data is limited. These limitations put your company at risk for overpayment and under insuring your employees. With the Unified Group Services, you can access your claims data as current as yesterday’s close of business. This allows you to customize your benefits and value-added programs to build a better work environment with healthy staff.

With a self-funded plan, your company can take control of your assets and cash flow while providing a customized solution to health and wellness for your company.

Selecting Your TPA

Selecting the right benefit plan administrator makes a big difference in the quality of benefits you and your customers receive. Asking the right questions up front will allow you to find the benefit plan administrator that best meets your customers’ needs.

Here are some questions you should consider when consulting your customers on their benefit plan administration:

  • Will I receive compliance updates to stay ahead of changing regulations?
  • Will I have a dedicated account manager for my business?
  • Will I have full access to up to date Medical, Rx, Dental, Vision reporting? At no additional charge?
  • Will my client have a dedicated team?
  • What is the accuracy of payments on claims?
  • How quickly are claims processed and paid?

Remember how involved your administrator will be in the delivery of your customer’s benefits and weigh your administrator options just as carefully as the benefit plans themselves.

How to Find a Trustworthy Benefits Adminstrator

Choosing a benefits administrator can be a daunting task. Who can you trust to provide quality reporting and communication that keeps your company’s best interests in mind?

Below is a list of 6 key factors to consider when selecting a health benefits administrator:

  1. Do they treat you like a person rather than a number? That number could be a dollar sign, a ranking of value to their bottom line or an account number rather than a name. Do a little research on how they treat their customers. For example, are customers greeted by a live-person when they call or forced to navigate a cumbersome automated system?
  2. Are they dedicated to customer service or do they take you for granted once the sale is complete? Learn about their long-term plan with their customers. Do they file accounts away and never look at them again or do they invest in your business with long-term analysis? You want an administrator who will monitor the health-plan landscape and continually customize your plan to better serve your needs and objectives.
  3. Do they care about accuracy or push every claim through automatically? Their accuracy rate on payment of claims will directly impact your bottom-line. Accurate administrators will provide you with a dedicated claims account manager who is assigned to handle your claims processing and available to answer any inquiries from employees and providers. If they don’t provide this, then keep looking, as claims accuracy is an important part of your benefits service that needs to be done correctly the first time.
  4. Do they provide your business with custom solutions or an off-the-shelf answer that may not meet all of your needs? Be sure your TPA or Carrier understands that your business is unique and the goals you have with your benefit plan is specific to your company. Specific goals require a custom solution. There are Third Party Administrators who provide custom solutions that will meet every need you have for your benefit plan.
  5. Do they have the right kind of support to keep you informed and aware of your benefit plan and compliance obligations? Check to see if your benefit administrator offers you access to compliance tools and resources. A compliance dashboard helps employers understand and meet their compliance obligations. A customer-focused administrator will provide an in-house compliance specialist who is available for consultation and to answer the questions you may have around the changing health care environment.
  6. Do they provide robust reporting to keep you in-the-know on your account activity? Find a claims administrator that offers 24/7 access to reporting that includes next-day claims information. Ask if their reporting is secure and provides you benefit plan details, and deductible status for your review. There may be times when you will need custom reporting. Find out if the benefit plan administrator offers custom reporting and if so, what additional fees apply. Be sure, before you select your benefit plan administrator, that you are able to access a complete picture of your benefit plan.

Choosing a trustworthy health benefit plan administrator can seem impossible, but it doesn’t have to be if you know what to look for and do a little research ahead of time.

Contact Unified Group Services to find out how we can provide quality claims administration and customer service excellence.