Labor & Employment Law & Human Resources Counseling on Behalf of Management

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?