SOW Checklist Flashcards
Health and Welfare Program Assessment and Strategic Planning
Conduct Health and Welfare Program Assessment to establish short- and long-term benefit plan objectives, including benefits offered, plan design, employee/employer cost sharing, role of voluntary benefits, etc.
Review possible future program modifications and financial impact to complement the Client’s objectives
Develop and monitor strategic plan, with emphasis on benefits offered, plan design, total cost, and employee contributions
Analyze relevant normative data to ensure the Client is within its desired range
Renewal and Marketing
Coordinate renewal activities with all carriers/administrators
Quantify financial impact of renewal; negotiate variance between renewal and Lockton projections
Prepare and present detailed renewal report, including Lockton recommendations
Prepare and distribute Request for Proposal if marketing is necessary
Direct and coordinate marketing process and carrier data requests Prepare and present Marketing Report, detailing current and proposed costs, provider networks, service capabilities, plan designs, vendor
evaluations, etc.
Prepare and submit Executive Summary of final recommendations, including marginal cost analysis associated with program changes and/or price changes
Claims Experience/Financial Analysis
Prepare paid claims analysis, detailing paid claims, projected claims, plan enrollment, and large claimants
Prepare preliminary renewal projection based on claims analysis
Prepare claims management report, detailing claims paid by type of service, diagnostic category, in- vs. out-of-network, brand drug vs. generic
drug utilization, etc. (based on carrier reporting capabilities)
Analyze claims history to determine most appropriate method of medical and/or dental financing (e.g. fully insured, self-insured, minimum premium, etc.)
Health Risk Management Services
Develop wellness/intervention and disease management program to help mitigate future claims with assistance from Lockton’s Medical Director
and Director of Health Risk Management
Identify claims trends with Lockton’s physician guidance
Interact with carrier or outsourced disease management firm using Infolock® claims analytics tool when available to aggressively pursue identified high-risk claimants
Monitor Health Risk Management program results to ensure objectives are met; modify as appropriate
Compliance Services
Access to Lockton’s in-house Compliance Department for assistance with:
- ERISA and state insurance law; COBRA and HIPAA; Title VII, FMLA, and USERRA; Tax Code welfare; Tax Code retirement
- Legislation affecting benefit program
- ERISA requirements via “ERISA Calendar”
- Document preparation and review
- Compliance audits and reporting
Other services include online seminars and workshops, compliance newsletters, and newsflashes/alerts delivered via email
Coordinate gathering of Schedule A reports to facilitate preparation of Form 5500
Prepare signature-ready Form 5500
Actuarial Services
Provide comprehensive actuarial services, including:
• IBNR reserve certification As needed
- Actuarial valuation of benefit plan design changes As needed
- Stop loss analysis, including Analysis of the difference in risk between various stop loss levels
− Estimate of expected number and dollar of claims above the specific stop loss deductible
− Probability that aggregate claims will exceed various levels
− Comparison of provider network reimbursement levels by network
− Medicare Part D actuarial attestation
− Medicare Part D claims submission
− COBRA rate certification
− Analysis of funding options (fully insured vs. self-insured)
− Detailed analysis of claims data to identify problem areas, estimate impact of plan changes, project enrollment for multioption plans, etc.
− Multi-option plan modeling, including cost projections,
employee contribution strategies, and enrollment migration estimates
