Third Party Administrator Services
Stop Loss Procurement
- Traditional Stop Loss Products
- Level Funded Products
- Captive Products
- Reference Based Pricing
Intelligent underwriting and the right stop loss product is critical to ensuring effective cash flow and assets protection. Insight works to understand your short and long-term goals -- are you focused on fixed costs, maximum claim exposure or some combination? Is employee engagement via wellness requirements an option? Will your cash flow better fit with a monthly budgeted amount or are spikes in claim costs easily absorbed? Insight performs internal discovery, identifies the financial goals for the organization, and shops the most competitive stop loss markets and related products to secure competitive pricing.
We have access to several carriers and stop loss products* and services including:
- Traditional Stop Loss with Specific and Aggregate coverage or Aggregate Only coverage
- Level Funding coverage
- Captive Stop Loss coverage
- VEBA coverage
Our A+ rated stop loss partners canvas the right market for the best fit based on industry, demographics, logistics and other considerations.
*Voluntary/Mandatory individual underwriting applications are available on certain products.
Our E.A.S.E. approach ensures effective communications for employer and member alike. We work to understand the culture of the organization and create specific messaging to make the transition experience as seamless as possible. We collaborate with the agent, employer, employees and members to provide an effective rollout of the benefits package.
E.A.S.E. components for a successful enrollment include:
- Developing tailored easy to understand welcome kits and enrollment instructions
- Identifying and emphasizing important plan design changes
- Providing both paper and on-line enrollment resources
- Holding informational group and individual open enrollment sessions
- Tracking and monitoring outstanding enrollments
The EASE protocols ensure the employer, employees and dependents understand the process and have the necessary tools to enroll timely and provides consistency in handling ongoing adds/changes/terminations.
Plan Design Review
- Ancillary Plans
- Case/Care/Disease Management
Plan Design decisions are at the foundation of remaining competitive in the market. Employers want to offer a comprehensive benefits package while at the same time ensuring that plans are sustainable. A strategically designed self-funded plan achieves both. Whether employers are moving from a fully insured plan to a self-funded plan with Insight or from a self-funded administrator to Insight, it is important to benchmark all aspects of a plan design to determine benefit relevance and compliance.
Key components to improved plan design:
- Introducing industry leading Care Management and Disease Management programs
- Employing carve-out benefits for high dollar claims such as Dialysis and Transplants
- Providing comprehensive pharmacy benefit programs for prescription costs
- Implementing high-tech radiology service alternatives
- Incorporating best practice language for coordinating benefits
- Incentivizing members with lower out-of-pocket costs when redirecting care
- Introducing, monitoring and measuring wellness programs and resulting outcomes
Insight's experience in benefit design assists in the creation of medical, prescription and ancillary benefits that encourage and support cost-containment and long-term sustainability.
Enrollment & Fulfillment
- Eligibility Review
- Employer/Member Communications & Education
- On-Site Open Enrollment Sessions
- Online Enrollment Functionality
Claim Administration & Compliance
- Claim Review and Auditing (In and Out of Network)
- Plan Reporting
- Benefit Modeling
- Compliance (ACA, Dept. of Labor, HIPAA)
Aggressive claim review provides cost containment and translates to managing fixed cost and stop loss premium increases. Our claim processing system logic, combined with additional independent review points, provides three levels of claim editing. This comprehensive approach to ensures that every procedure is appropriate and every dollar spent is justified. Insight vendor partners integrate with the claim logic to maximize savings and minimize claim payment errors.
Our operations include:
- Reviewing for appropriateness of billing
- Investigating for potential third-party liability
- Benchmarking best practices and fees for similar diagnoses and procedures
- Monitoring trends in dashboard reporting
- Delivering comprehensive and robust claim reporting
- Ensuring legislative compliance (e.g. ACA, HIPAA, COBRA, IRC 125)
Deploying multiple review edits and the best-in-industry standards results in trend well below industry average. Ensuring compliance avoids penalties and other service issues for the employer.