Understanding Your Group

There are many factors to consider when designing your employee benefit program. It starts with a general understanding of where your organization is today, and strategizing where it wants to be in the short and long term. We start with the basics:

  • Headquarters and Satellite Locations
  • Organizational Culture
  • Industry Type
  • Corporate Philosophy
  • Employee, Retiree and Union populations
  • Budget Considerations
  • Employee Classifications
  • Census Data
  • Staffing Fluctuations
  • Common Control
  • Eligibility Guidelines
  • Contribution Schematics

Reviewing Your Program

The J.S. Clark Agency works directly with you to ensure our understanding of both your short and long term financial goals and benefit objectives. We offer a complete menu of plan design options for you to choose from:

  • Medical and Prescription Drugs
  • Global Medical Plans
  • Dental
  • Travel Accident Coverage
  • Vision
  • Flexible Spending Accounts
  • Life and AD&D
  • Health/Medical Reimbursement
  • Short and Long Term Disability
  • Health Savings Accounts
  • Long Term Care
  • Critical Illness and Accident Plans
  • Wellness Programs

Plan Design Considerations

The Affordable Care Act (ACA) has changed the way businesses design their benefit plans. In today’s environment, there are many variables that will impact the success of your benefits program. Some common considerations are:

  • Program Types (PPO, HMO, EPO, Etc.)
  • Coordination of Benefits
  • Retiree Plan Design
  • ACA Minimum Essential Benefits
  • Copayment Structures
  • ACA Actuarial Value
  • Deductible Management
  • ACA Subsidy Analysis
  • Formulary Management
  • ACA Out of Pocket Maximums

Carrier Considerations

Our analysis includes a review of the financial performance of all existing plans. We conduct a thorough service evaluation of the existing or prospective carrier. We then compare our research with both industry and geographic norms, examining the following areas:

  • Network Availability/Utilization/Discounts
  • Financial Ratings
  • Rating Structures
  • Data Mining Programs
  • Funding Mechanisms
  • Claims Management Systems
  • Claims Utilization
  • Case/Disease Management
  • Settlement Options

Renewal Process

The renewal process begins three to five months before renewal date. We start by working with you to obtain an updated employee census, copies of the most recent insurance billings and confirm premium contributions. We also take a look at:

  • Claims Utilization Review
    • Benefit Plan Usage
      • Emergency Room versus Urgent Care
      • Generic versus Brand Medications
      • In-Hospitalizations
    • Case/Disease Management Opportunities
    • Renewal Forecast
  • Identify any Union Negotiation Preparations
  • Plan Design Options
  • Carrier/Network Options
  • Funding Options
  • Eligibility Provisions
  • Contribution Strategies
  • Tax-Savings Plan Options
  • Renewal Pricing
  • Alternate Plans and Carrier Pricing
  • Alternate Concepts
  • Finalize Plans
  • Finalize Contributions
  • Prepare for Open Enrollment
  • Begin Preparation for New Hires

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