Get your benefit plans “back to basics.”

It’s that time of year again.

Here we are at the end of August. This time of year always makes me want to go back to school. It has actually been many years since I went back to school in September, but I have never quite gotten over the feeling. It could be the excitement of reuniting with friends I hadn’t seen in a couple of months, but it is more than likely getting new clothes that caught my attention. This year I am using this wave of enthusiasm to get back to basics. I am committed to running regularly and eating right, for both my health and a race in November and, professionally, I am committed to going back to basics with my clients and their benefit plans. Here are a few back-to-basics benefits essentials.

“Clear concise communication contributes to employee satisfaction with the plan and helps avoid misunderstanding about coverage.” Lizann Reitmeier, Health Practice Leader, Toronto
“A ‘back-to-basics’ review can help to highlight opportunities for improvement.” Lizann Reitmeier, Health Practice Leader, Toronto

Benefit philosophy/strategy

A plan sponsor’s benefit strategy provides a solid base for guiding benefit decisions. Like most things in life, it requires occasional maintenance. As our world—and your business— changes, that strategy may require some updates to stay relevant.

Plan design review

Plan designs have often been driven by what the insurer market would provide, especially for smaller groups. As businesses grow and markets change, there may be opportunities to update a plan design to better align with your strategy and corporate goals.

Claims analysis/claims audit

Wondering where the money is going? In most benefit plans, the biggest expense currently is typically the Health plan. While Dental claims have escalated quickly, Health plans tend to drive the cost for most employers. A review of the claims experience can help determine the cost drivers. Are claims being paid correctly? Is there an unusual trend? Was there a large one-time claim? Are some claims cost preventable through education/wellness support/flu shots/job modification? These can all be determined through a review of the claims. A full blown claims audit provides the ultimate sense of security by highlighting any deviations from the contract as well as from market practice, while a review of claims distributions can help determine the most prevalent medical conditions in your workforce.

Contract and booklet review

As noted in my last post, contract and booklet wording can be complex. The recent ruling in British Columbia Superior Court, Feldstein v 364 Northern Development Corp, confirms, employers have an obligation to communicate benefit plans clearly and correctly. Of course, this ruling did not apply to orthotics, the example in my last post, but rather to the communication of the pre-existing condition exclusion under the LTD plan. It is important that communications detail the limitations and exclusions in a way that plan members can understand. Are your plan documents up to the challenge? It might be time for a review.

Plan administration

While there are several methods of passing employee information to insurers for billing and claims administration, ultimately all data has one source – the employer. No one other than the employer can confirm the details of the employment agreement, such as effective date of coverage, hours worked and earnings. This is a serious obligation, as errors can result in employees not having coverage, or having less coverage than promised, potentially exposing the policyholder to an uninsured risk.

Plan sponsors are also responsible for the cost sharing arrangements, which may impact the tax status of benefits. And did I mention waiver of premium claims? Plan sponsors with workers’ compensation claims or who have LTD and life insurance with separate carriers need to ensure claims are filed for waiver of premium for the life insurance. Are employees signing appropriate waivers when they opt out of coverage and providing appropriate authorizations for the use of personal information in the administration of the plan? Administration is a serious obligation and can take a considerable amount of time. A “back-to-basics” review can help to highlight opportunities for improvement.

So, it looks like there is a lot to think about as we hit the books this fall! Let’s welcome September with open arms and get back to the basics of benefits.

Your turn: Use the comment box below to us know what you do to get “back to basics” with your employee benefits programs.

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