Topic 4: Benefit Communication

Question 1

What Is The Importance of Benefits Communication

Answer 1

1. Improve or enhance EE satisfaction with benefits
2. Enhance value to ER and EE
3. Helps with compliance and discrimination testing

Question 2

Required Benefits Communications Under ERISA

Answer 2

1. SPD: Summary Plan Description
2. SMM: Summary of Material Modification
3. SBC: Summary of Benefits and Coverage
4. Exchange Document

Question 3

Communication Options

Answer 3

1. Paper
2. Electronic
3. Face to Face Meetings
   - New EE orientations
   - Periodic Meetings
4. News Letters
5. Personalized Benefit Statements

Question 4

Who Should Administer The Plan?

Answer 4

1. In House
2. Outsourced
   - Insurer: Coverage Provider
   - Insurer: ASO Contract, no risk bearer
   - Non Insurance Firms: TPA (Third Party Administrator)

Question 5

TPA Vs ASO

Answer 5

• In both someone else is doing admin
• Non Insurer = ASO
• Insurer = TPA

Question 6

Types of Admin Activities

Answer 6

1. Enrollment
2. Claims Handeling
3. Communication Activities
4. Compliance