Strategic Benefit Management Flashcards
Strategic Benefit Management
Disadvantages of Outsourcing
- Can result in fragmentation and lack of integration in database
- Communications can vary causing confusion among participants
Strategic Benefit Management
Advantages of Outsourcing
- Benefit admin complexity
- Efficiencies of specialized providers
- Beneficial pricing
- Monitor trends
Strategic Benefit Management
What Drives Complexity in Administering Benefit Programs?
- Complexity and comprehensiveness of benefit design
- Size of EE group covered
- Uniformity of program for different categories of EEs
- Geographic dispersion of EES
- Self-funded plans
Strategic Benefit Management
Benefit Director Competencies
- Plan Design
- Plan Delivery
- Benefits Policy Formulation
- Communications
- Applying Technology
- Cost Management and Resource Controls
- Management Reporting
- Legal and Regulatory Compliance
- Monitoring External Environment
Strategic Benefit Management
What Impacts Benefit Design?
- Cost considerations
- Culture
- EE needs
- Historical development of program
- Industry trends
- Local market conditions (service providers)
- Collective bargaining agreements
- Union negotiations
Strategic Benefit Management
ACA Impact on Benefit Design
- Mandate that individuals attain health coverage
- Restructure plan offerings by insurers and health plan providers
- Tax incentives and subsidies to make health coverage affordable
- Individuals select plans through state exchanges if offerings are more attractive than an ER’s plan
Strategic Benefit Management
Benefit Plan Delivery Critical Activities
- New EE Benefit Orientation
- Policy Clarification (Eligibility, Coverage)
- Handle exceptional circumstances
- Process enrollment/claims data
- Benefits counseling and response to EE inquiries
Strategic Benefit Management
What do benefit plan delivery critical activities depend on?
- Scope of benefits program
- Nature of organization
- Characteristics of EE workforce
Strategic Benefit Management
Quality Standards to Evaluate Customer Service
- Desired quality as determined by management
- Standards that ensure program is in compliance with regulations
Strategic Benefit Management
Benefit Policy Formulation
- Human Resource Questions
- Vendor Summits (to promote communication and answer questions)
Strategic Benefit Management
What makes benefit plan communication challenging?
- Diverse workforce
- Some benefits are of little interest to EEs until point of use
- Multiple regulatory requirements lead to confusion
Strategic Benefit Management
Targeted Communications
Must be provided when specific conditions are met:
- Benefit statement to terminated vested participants
- COBRA rights
- Explanation of tax withholding for rollover distributions
- Joint/Survivor information
- Certificates of creditable coverage (HIPAA)
Strategic Benefit Management
General Federal Communication Requirements
- Summary Plan Descriptions (SPD) = plan provisions in easy language
- Summary of Material Modifications (SMM)
- Summary Annual Report (SAR)
Strategic Benefit Management
Applying Technology
- Informational Architecture = Obtain and Store
- Data-Accessing Capabilities = Retrieve data
- End-User Tools = Easily extract data
- Multiple Users = Administrators and participants
- EIS = Executive Information Systems = provide management information in summary
Strategic Benefit Management
Management Information Systems
Allow benefit management to monitor:
- financial results
- utilization
- risk exposures
- deviations from compliance targets
