Employee Benefits Consulting

• Program Design & Placement
• Claims & Disease Management
• Funding Evaluation
• Network Performance
• Cost Share Analysis
• Wellness Engineering
• Compliance

Employee Care Center

• Communications
• Administrative Services
• Claims Advocacy
• Web Enrollment
• Call Center

HR Consulting Services

• Outsourcing
• Compliance
• Recruiting
• HR Assessment
• Training
• Benefit Record Systems

Employee Benefits Consulting

Program Design & Placement

The services of Connelly, Carlisle, Fields & Nichols are dictated by the unique needs of our clients. The illustration below outlines the core services we provide to aid our clients in creating and implementing an effective benefits program.

Analyze Program

We will analyze various data in order to project future costs. The data we will analyze includes:

• Benchmarking current data, costs, and budget to Industry and National trends
• Analyzing demographic information
• Comparison to prior years

Craft Strategy

We will work with you to craft short-term, mid-term, and long-term goals based on your business plans, understanding that business opportunities and requirements dictate priorities. Your firm’s distinct culture will be taken into consideration when developing and executing the benefits strategies. Various inputs considered when helping to craft your benefits strategy will include:

• Administration feedback and business plan
• Growth plans
• Financial objectives

CCF&N is prepared to manage all aspects of the marketing and placement of all of your organization’s benefits programs. We will collectively determine up to six months in advance if you are going to seek alternatives in the marketplace. The decision on whether or not to market coverages will be based on several factors, such as service satisfaction with the provider, the cost of services, plan flexibility, etc.

At this pre-renewal planning meeting, we will provide an evaluation of market conditions for all coverages based on our personal experience as well as industry data and forecasts. Our analysis of market conditions will also be included as part of our Executive Summary in our Renewal Presentation (if coverages have not been marketed) or our Marketing Presentation (if coverages have been marketed).

Our marketing services can include any and all programs such as medical, dental, life, disability, employee assistance plan, vision, long term care, retirement, etc. We will develop detailed marketing specifications based on those factors most important to you. When proposals are received, we will analyze all the various cost components and services on a standardized basis. This information will be used to make recommendations on final carrier and plan choices to you.

CCF&N’s colleagues hold non-residence licenses in all states. As a result, we are able to access any national, regional, or local provider. In addition, our market clout gives us the following status with key group insurance markets:

• Aetna – Chairmen’s Club
• Blue Cross Blue Shield of Florida – Diamond Agency
• Cigna / Great West – Platinum Broker
• Humana – Leader’s Club
• United HealthCare – Platinum Agency and Ranked # 1 UHC Broker in 2005 (for groups 2 – 99)

Implement Action Plan

In order to execute the plan, we will create an annual service calendar of specific activities we will undertake on your behalf and a schedule of when we will accomplish each item. Key activities will be centered on helping you most effectively manage your healthcare costs given your business objectives.

Steward the Plan

Each year we will provide you with a stewardship report that will outline what actions we have undertaken on your behalf and how we have performed based on the service commitment outlined in the service plan provided to you.

Claims & Disease Management

We use tools allows us to analyze your benefits plan costs against reliable benchmark information, project the impact of medical plan design changes, estimate your renewal costs, and streamline the plan selection process for your employees. This resources is available free of charge and provided annually.

In addition, we can contract with a third party auditing firm with considerable expertise in validating the accuracy of claims costs and then identifying major cost drivers. Audit deliverables typically include statistically valid benchmark performance measurements, data mining, exception edit results and recommendations that lead to ownership of the key administrative policies and procedures that drive plan costs and impact employee satisfaction. Services available include:

• Quarterly or Semi-Annual Claims Extract Analysis – to identify major cost drivers and efficiency opportunities. Their analysis of both the number of units of care and the cost per unit will arm us with valuable consultative opportunities. They will conduct a high level review to identify specific payment anomalies, such as:
  • Duplicate payments
  • Claims priced without the appropriate discount
  • Claims paid as primary when your plan should be the secondary payor
  • Major accident claims where subrogation has not been pursued
  • Claims that were incurred after plan participants were terminated, yet paid in error
  • Claims that were for excluded or limited services
• Annual Claims Audit and Large Claims Audit – Annual audit deliverables will include statistically valid benchmark performance measurements, data mining, exception edit results and recommendations that lead to ownership of the key administrative policies and procedures that drive plan costs and impact employee satisfaction.

Timely and thorough analysis of claims is needed in order to help you develop and monitor cost projects compared to budget.

The primary tools we use to monitor cost projections are:

• Weekly: If needed, establish weekly notification process from medical carrier of any individual claim in excess of half of the specific level and whenever paid claims for the week exceed projections. (If claims are funded monthly, this information would be provided monthly.)
• Monthly: Download monthly claim reports from medical carrier and provide an executive summary along with the following key measurements, The Table of Truth, which will include such components as:
  • Average monthly surplus or deficit to funding rates
  • Average paid claims per employee and member
  • Top claim diagnosis based on amount paid
  • Top paid providers based on amount paid
  • Total monthly surplus or deficit to monthly claims per employee and member projections and to aggregate claims projections
  • Total paid claims broken out by medical and pharmacy providers

Funding Evaluation

As a part of the comprehensive program design and placement, we will provide recommendations on funding alternatives, including:

• Benefits and possible limitations of self-funding
• Appropriate levels of stop loss
• Aggregate stop loss contracts
• Viability of aggregating specific
• Appropriate funding rates associated with each arrangement
• Calculation of Incurred But Not Reported (IBNR) claims analysis

In order to effectively budget for each employee benefits program, your leadership needs to be provided recommendations and advance notice of any possible changes to the proposed funding levels.

Network Performance

One of the most critical components of a well performing health insurance plan is the strength of the carrier’s network discounts in order to control costs. Our market analysis includes a re-pricing of your group’s highest claims with each viable insurer as well as quarterly and annual feedback on how your group’s network discounts compare to the insurer’s block of business as a whole.

When we uncover an opportunity to reduce out of network claims, we will provide the specific employee communication needed to better educate employees on how to best maximize their plan while controlling costs.

Cost Share Analysis

With the increasing cost of healthcare, the reasons benefits are offered to employees should be examined. Many employers offer benefits to fulfill one or more of the following requirements:

• As a competitive advantage, differentiator, or requirement
• As an aide in recruitment and retention
• As a moral obligation
• As a cultural imperative
• As an efficient and economic way for employees to purchase financial protection

By weighting these example requirements and perhaps adding your own, changes to the benefits plan, including establishing a long term philosophy on employee contributions can more easily be accomplished as they can be measured against the philosophy.

We will take these items into consideration, along with the budget constraints of your organization in order to provide you with recommendations on appropriate employee contributions. In addition, we will also provide you with a benchmark analysis of what other similarly sized, geographically placed organizations in your industry are providing.

Wellness Engineering

We will assist you in the management and development of a true long term employee wellness program, including any of the following:

• Data analysis of disease management indicators and Health Risk Assessments (HRA) results
• Developing wellness goals and outcomes
• Imbedding wellness initiatives into the culture at your organization
• Expanding current offerings at annual Open Enrollment Fair to include wellness programs
• Provide recommendations and alternatives to existing wellness credit/rebate program, if desired.

Wellness initiatives will be focused on claims prevalent to your group and given demographics.

Compliance

CCF&N is available to review employment policies to ensure compliance as well as training for managers who deal with employee hiring/terminating.

We believe the success of your benefits plan is determined by many factors. A considerable factor is the accuracy of the process. CCF&N will assist in every step of the benefits process to ensure simplicity and accuracy to reduce your exposure and liability. Some of examples of this assistance include:

• ERISA – CCF&N will keep you apprised of ERISA changes that may impact your benefits, Summary Plan Descriptions, or communication requirements to your employees.
• SPD Distribution – According to ERISA, you are required to provide copies of the current SPD’s to your employees within 90 days (120 if a new plan) of the effective date. As many carriers are no longer providing hard copies of the documents, many employers are now required to print and distribute the SPD. With changing technology, employers can provide this document electronically and still remain in compliance.
• Medicare Part D – In 2004, Medicare revised the prescription coverage. This change brought about additional responsibilities for employers. Companies providing prescription coverage to their employees must notify the Centers for Medicare and Medicaid Services and the employees prior to the deadline as to whether or not their plan meets the definition of Credible Coverage.
• COBRA Compliance – As a group greater than 20 employees, according to Federal Regulations, your firm is required to offer COBRA coverage to their employees. CCF&N will review your current processes and vendor to ensure compliance is maintained.
• HIPAA – This regulation requires employers to, among other things, maintain Protected Health Information. However, employees still have the need for assistance in working through escalated claims issues. Our benefits colleagues are all certified as HIPAA compliant and we welcome the opportunity to help your employees with complex claim issues.

In addition, we provide our client with a customized portal that not only houses all necessary benefits information and links, but also includes a library of related topics and links:

• General Compliance: looking for quick answers to tough legislative questions? The Compliance section has the answers you’re searching for. You will be directly linked to an exclusive set of comprehensive guides full of federal legislation. Complete guides include COBRA, HIPAA, HIPAA Privacy, Section 125, and FMLA. Within each guide, sections include Related Articles, Q&A, Forms, and Quick Reference. A search function is also available to help you easily source information by allowing you to browse all or only particular sections within each guide.
• Documents on Command: when you need to resource information fast, the Documents on Command section provides instant access to a library of downloadable articles covering a variety of topics — exactly when you need them. Articles are conveniently grouped by general category and include: Benchmark Surveys & Statistics, Compliance & Plan Designs, and Employee Communication & Education — to help you easily locate all the resources available to you. Or, use its keyword search function to find related documents.
• Resources: provides useful links and articles to industry-related Web sites —all through the convenience of your homepage. In addition, use the helpful search function so you can promptly find all the information you are looking for, as well as any related documents from the Documents on Command section. So many helpful resources — all at your fingertips.
• Health Shop: for consumer-based health-related articles in professional looking newsletters to give to your employees in a snap? This feature supplies you with comprehensive consumer information, in ready-to-print newsletters. Topics include: At the Doctor’s Office, At the Pharmacy, Home Care, and Your Health. Use these newsletters to help your employees make smart and informed healthcare decisions.

Employee Care Center

Communications

Investing resources in employee education is a critical component of a comprehensive benefits strategy. We can participate in educating employees in a number of ways and believe that the employee benefit education process is built on the following elements:

Step 1: Understanding Plans and Options

In order for employees and their family members to make informed decisions about their annual health plan choices, they must understand the plan alternatives being offered. We can accomplish this by:

• Pre-Employment Offer Recruitment Benefits Overview
• New Hire Benefits Orientation Material
• Annual Benefit Open Enrollment Guide
• Pre-Benefits Fair Articles in Newsletter
• Open Enrollment Meetings
• Benefits Cost Comparison Worksheet

Step 2: Accessing Tools and Resources

Your firm offers a variety of resources to covered employees and their families. The various tools and resources that we will communicate to your employees include:

• Quick links to provider directories from intranet
• Newsletter supplements on plan “extras”
• Special interest articles on plan and provider changes

Step 3: Behavior Modification

As part of an overall wellness strategy that your firm should consider implementing, behavior modification is the cornerstone. We will manage your wellness initiatives that may include:

• Newsletter inserts on general wellness issues
• Targeted wellness campaigns, Biggest Loser Contests
• Wellness topic seminars

Step 4: Employee Enrichment

Periodic employee general educational opportunities are a part of your employees’ overall benefits experience. Sample topics include:

• Adding Exercise into Daily Activities
• Budgeting
• Care for Aging Parents
• Effectively Communicating with your Teenager
• Medicare 101
• Establishing a Will
• Establishing a 529 Plan
• Personal Hurricane Preparations
• Saving for Retirement
• Stress Management

Summary of Enrollment Support Services

CCF&N will provide a toll-free phone number for employees and/or dependents to call us with any questions related to the benefits offered following our Open Enrollment Meetings. This is an additional resource for employees who may have missed the meetings or thought of a question later and/or dependents involved in the benefits decisions for their family.

Administrative Services

To better assist our clients during open enrollment and/or throughout the plan year, we offer a variety of benefits administration services, including:

• Claims Advocacy*
• Web-based Enrollment Services
• Compliance Notices
• Eligibility Management*
• Premium Reconciliation*
• FMLA Authorization and Administration*
• Adoption Assistance Administration*
• Customized Service Reporting
• Call Center*

*While most of our services are provided at no additional charge, these are optional services and available for an additional fee.

Claims Advocacy

Claims Advocacy Services

CCF&N currently handles all escalated claims issues on behalf of your organization and its employees as part of our standard services. For sensitive issues, you may have members contact us directly for confidential assistance in claims resolution. Employees are required to complete a Release Request. This executed document would be forwarded to the appropriate provider and attached as a record on the employee’s service file. Information is stored and transmitted to maintain PHI and to remain HIPAA compliant.

We believe employees will not value their benefits and their employer’s associated expense with their benefits if they cannot appropriately access their plans. This is why we plan such an active role in helping employees navigate through escalated claims issues.

Medical Plan Advocacy Services

This additional service allows employees and their dependents to get more value out of their healthcare benefits, while at the same time helping them to become more educated purchasers of healthcare. Employees and dependents access this service through one-on-one personal assistance with qualified healthcare professionals to assist with:

• Medical questions
• Help finding the highest quality doctors and facilities in the area within the network
• Educating employees on their medical treatment options
• Identifying providers for second opinions
• Selecting alternative care settings
• Answering questions on dental and pharmacy related services
• Medical appeals to insurance companies and providers

These services are extending to dependents and other family members (parents and in-laws) of the covered employee, even if they are covered under a different health insurance plan. Employees are encouraged to call this service when:

• They want help identifying the best doctors within a network.
• They need information on physicians and medical facilities.
• They need a second opinion.
• They have health concerns.

Additional cost applies for Medical Plan Advocacy Services.

Web Enrollment

Employees are increasingly looking for more and better information from their employers, and the challenges for human resources professionals continue to mount. As the benefits landscape changes, newer and more efficient ways of communicating complicated benefits information are becoming more prevalent.

With our web-based enrollment, you will have access to a number of sorting, grouping, and categorization capabilities; a customizable menu system; and detailed benefits pages tailored to your company’s plans. Your employees will appreciate easy navigation and interactive features.

• Employee Data Module Features
• Vacation tracking and online vacation requests
• Customizable new employee orientation wizard
• Individual employee logins
• Employee data tracking
• Election Module Features
• Online benefit plan elections
• Life event administration
• Detailed reporting capabilities

Call Center

We will set up a dedicated toll-free phone number for your employees to provide the most effective tracking and to allow us to provide customized service to callers. CCF&N utilizes a call tracking system to report service in the following ways:

• Calls from employees will be routed in sequence based on who answered the last call in order to ensure fair distribution of calls (utilizing “idle agent” logic).
• Calls from your Human Resources Department will be skills-routed, assuming HR may still handle the bulk of critical claim issues.
• When call volume is unexpectedly high, Expected Wait Time announcements will let your employees know when to expect a response.
• Complex issues can be handled effectively as our call center colleagues can request supervisor assistance on the call. Supervisors can also monitor calls to ensure that quality standards are upheld.

This tracking provides an effective means to assist in validating client satisfaction at the employee level as well as serving as a helpful management and coaching tool. We use this information in determining lunch schedules, approving time off, and scheduling department meetings to provide more responsive service to you and your employees.

Our ECC system also has the capability to transfer calls to external locations, so employees calling our ECC who actually have a payroll question, for example, can be re-routed back to you without the caller having to place an additional call. This is also available when the caller needs to speak directly to an insurance company representative or other provider. Depending on the nature of the call, we can remain with the employee on the line to ensure their issue was handled appropriately.

HR Consulting Services

Outsourcing

In addition to our insurance company marketing expertise, we also have access to the area’s best qualified PEO companies. We provide objective, comprehensive, analysis of PEO proposals on behalf of our clients. This enables us to fully vet the cost structure of each proposal and help our clients evaluate the merits of each alternative compared to non-PEO structures. In addition, our expertise allows us to negotiate the best pricing, terms, and conditions on behalf of our clients.

Compliance

We encourage you to avail yourselves of our on-staff Senior Professional in Human Resources (SPHR), who is available to review employment policies such as:

• Sample HR Files
• Forms and Documents
• Performance Evaluations
• Legally Required/Suggested Policies
• HR Handbook
• Management Guides/Resources

Recruiting

We will assist you by reviewing your current recruiting practices, including advertising, benefits communication to potential candidates, application and application process and tracking as well as sample behavior-based interview questions.

HR Assessment

To help keep your organization on the cutting edge, CCF&N is prepared to assist you by conducting a full (or partial) HR assessment of all of your HR practices to provide an additional measure of security to ensure compliance as well as feedback to assist in improving department efficiency. Process includes:

• Review of printed materials
• Review of processes
• Review of documentation practices
• Review of file standards

Training

We will arrange professional compliance training courses to provide best practice guidance on mitigating your employment risk and educating your management. In addition to its value in your organization, a good faith effort to adopt anti-discrimination and anti-sexual harassment policies can defend your firm in a courtroom. Offering education and training on these programs is an affirmative defense against punitive damages in a compliance-related lawsuit. Suggested courses include:

• Sexual Harassment
• FMLA and ADA
• Legal Hiring Practices
• Managing Performance and Performance Appraisals

Benefit Record Systems

We will review your current Benefit Record System to ensure HIPAA compliance as well as to provide feedback to improve the efficiency of the current system. In addition, we will assist you in evaluating alternative Benefit Record Systems.