Benefits Administration John Ykema, Director of Sales & Marketing

AgendaOverview

Plan Management

Benefits Underwriting & Quoting

Client & Employee Management

Process Management

OverviewLet's Get Started:

• What is your current Benefits Administration model?• Agents• Quoting & Underwriting• Claims Advocacy• Change Management Process

• What is your Benefits Plan structure?• Master Plans• Client Level Plans• Risk Tiers• Age Banding

• How will this impact your Payroll System?

• How will this be managed during Client / Plan renewal?

Plan Management

Master Benefits Plans

• Setup and Managed in Admin Workspace• Benefits Plan

Dataform• Assigned to

Prospect/Client as Offered Benefit Plans

Master Benefits Plans

• Plan Category• Status and Workflow• Premium vs True Cost• Base Plan• Comparison• Reconciliation

Model Benefits Plans

• Template Benefits Plans• Typically setup with

everything but rates filled in.

Client Level Benefits Plans

• Benefits Plans added directly to Client Workspace.

• Added from Scratch or Cloned from Model.

Risk Tiers

• Master Plan Tiers or• Client Level Bands• Supports Premium vs

True Cost

Benefits Underwriting & Quoting

Benefits Underwriting

• If Client Master, Health Benefits = Yes.• Then the Benefits

Underwriting record will be generated.

Benefits Pricing

• Benefits Tier Definition• Average Age & Percent

Male• Control Tier• Calculated Tier• Final Tier• PreSale Benefits Plans

Offered Benefit Plans

• How Benefit Plans are offered to the Client and in turn the Employees.• Offered Plan Workflow• Rate Grid• Contributions• HRA & HSA

Benefits Comparison

• Reports and Merges• Pulls data from :• PreSales Plans• Offered Plans

Example Excel Merge

Offered Plan Activation

Once the prospect has selected which benefits plans they would like. You should Activate the Offered Benefit Plans so that they can be associated with the enrolled employees.

Client & Employee Management

Company Benefits

• BOR/AOR Dates and Letters• Eligibility Tracking• Waiting Period by

Classification• Document

Management

Employee Benefits Management

• Enrollment Tracking• Employee Benefits

Renewal.• Used in Recon for

Data Validation.

Deduction Voucher Tracking

• Deduction History From Payroll system.• Many per Voucher.• Both Credits and Debits.• Used in Recon.

Process Management

Internal Administrative Process• Ensuring Client is matched up to the best plan for both them

and you.• Ensuring that Employee elections translate to smooth

Carrier enrollment and Payroll system setup.• Change Management. • Process Workflows.

Renewal Management

• Schedule Template Tasks or Cases• Process management

and enrollment auditing.• Historical Employee

Election Tracking

Relationship to Payroll System

• System of Record?• ClientSpace

• Largely disconnected, but there is hope.• HRP API in the works.• Data Imports are

available.

Relationship to Reconciliation

• It all builds toward the reconciliation tool.• Data Standards and

validation.• Less Exceptions