Benefits Administration Flashcards
1
Q
What are the requirements of administering benefits plans?
A
- general and managerial skills
- technical proficiencies in several areas
- involves coordinating a team of internal and external specialists from: HR, law, tax, finance, medical care, risk management and IT
- skill in leadership, communications, project management, and general management
2
Q
What are examples of administration arrangements?
A
- Insurer Administration
- ASO- Administrative Services Only
- Self-Administration
- TPA- Third Party Administration
3
Q
Discuss outsourcing. (TPA/ASO)
A
- complexity of the function
- efficiencies from specialized service providers
- beneficial pricing due to business volume
- ease of implementing technology
4
Q
What is the range of services from outsourcing?
A
- enrolment
- communications
- claims admin
- reporting
- ASO
5
Q
What is the benefits admin manual?
A
- provided by the insurer
- customized by the employer
- used by HR
- contains details regarding status changes, benefits continuance, termination, reinstatement, coordination of benefits, etc.
- eligibility, enrolment
6
Q
Discuss enrolment.
A
- employer drives this=need to collect, maintain, and communicate ee enrolment information
- communicate to insurer, TPA/ASO
7
Q
What does OHIO stand for?
A
Only Handle It Once
8
Q
How do we maintain records?
A
- employer bears burden of responsibility to maintain employee records to a satisfactory level
- employee bears a burden of responsibility to inform insurer and/employer of material changes in status
9
Q
What is included in a plan review?
A
- done with your broker/consultant
- detailed review of plan coverages, usage, cost and performance
10
Q
What are HR related activities in benefits admin.?
A
- price/feature negotiation
- benefits orientation & enrolment
- plan details communication
- claims admin
- benefits counselling
- plan review
- management reporting
11
Q
What are some communication challenges?
A
- diverse workforce
- lack of interest until point of access/utilization
- multi-regional/national legal and tax jurisdictions
- increased program choices and associated complexity
- changing technologies
12
Q
How can we minimize communication challenges?
A
- use multichannel approach
- communicate frequently
- use total comp statements
13
Q
Discuss cost management.
A
- increasingly assumed by HR (from Finance)
- knowledge of insurance pricing:
program metrics
medical procedures, etc.
achievement of HR objectives
underlying actuarial assumptions and reserve reqs and comparison of these with actual plan experience
14
Q
What are analytical mehtods?
A
- actually payable to rep employees
- actual costs to the employer
- measure plans
- compare plans
15
Q
Discuss Pacific Blue Cross.
A
- not for profit
- group plans
- direct to end user
- 1.5 million BC covered
