Paul Shaheen, Vice President of The Horton Group (an insurance broker that provides risk management and employee benefits to businesses of all sizes), provided me with a copy of their employer benefits survey. It provides an interesting overview concerning what businesses should consider when choosing benefits plans.

The following is a selection of topics from the survey which a business should examine prior to choosing an employee benefits plan.

If you’d like a copy of the complete survey in PDF format, please don’t hesitate to contact me.

Assessment & Review

  • Do you have a formal process to survey employees annually for feedback and rate their satisfaction with the plan?
  • Is your plan aligned with your company’s business plan?
  • Have you implemented or reviewed alternate funding options, such as transplants or specialty pharmacy?
  • Have you forecasted the current cost over the next five years?
  • Have you defined your benefit philosophy?
  • Have you benchmarked your cost sharing with employees against industry averages?
  • Does your plan maintain 75% or greater employee participation after valid waivers?
  • Have you benchmarked your plan rates against industry averages?

Your Plan Design

  • Do you offer more than one plan design?
  • Is at least one plan consumer directed?
  • Do you allow for employee pre-tax premium contributions?
  • Do you have a separate program for retirees?
  • Do you have a voluntary Medicare migration strategy?
  • Does your plan include affordable options for low-wage earners?
  • Have you had more than 2 carriers in the last 5 years?
  • Do you provide an EAP with work/Family Program?

Shopping Your Plan

  • Are you aware of the carrier markets for your size and type of plan?
  • Have you shopped both brokers and direct benefits vendors?
  • Have you reviewed network alternatives, access, disruption and utilization?
  • Does your contract include network discount guarantees?
  • Does your plan include a proactive out-reach disease management program?
  • Has your pharmacy benefit manager shown you all fees and rebates for your plan?

Is Your Plan Legal?

  • Have you sent out Medicare Part D certificates to eligible participants and dependents?
  • Have you audited your 5500 process?
  • Do you outsource or have a tool to manage COBRA?
  • Do you outsource or have a tool to manage FMLA?
  • Do you receive legislative/Compliance updates monthly?
  • Have you contained Personal Health Information to a Privacy Officer?

Communication/Administration Tools

  • Do you track hits on your benefit website for employee/spouse?
  • Do you annually update employee beneficiary elections?
  • Do you provide a HIPAA compliant resource for escalated claim assistance?
  • Do you provide tools for new hire and spouse to review options with guidance on how to make best use of the program?
  • Does your HR unit operate in a paperless environment for open enrollment, life events, monthly adds and terms?

Proactive Wellness

  • Does your plan cover an annual adult physical?
  • Do you use incentives to drive participation in wellness activities?
  • Do you hold an Annual Benefits and Wellness Fair?
  • Do you use a Health Risk Appraisal and aggregate the data?
  • Does senior management play a role in your wellness activities?
  • Do you have a wellness committee working from a written business plan?
  • Do you offer professional coaching assistance to employees at risk and/or wanting to improve?

Employee Education

  • Do you use benefit statements to share the full benefit cost?
  • Do you conduct annual open enrollment meetings?
  • Do you offer lunch-and-team sessions on relevant topics?
  • Do the employees / dependents know all the resources offered by your carriers and how and when to use them?
  • Does your communication campaign reach spouses?

Claims Review

  • Do you know the loss ratio for your plan?
  • Do you annually benchmark utilization?
  • Do you perform a claims audit on your carrier or third party administrator?
  • Do you drill down into your claims to determine root causes?
  • Do you review prognosis, diagnosis, and cost of large claims?
  • Does your group use 90% in-network providers?
  • Do you track the number of inpatient admissions with cost and average stay?