• Review and evaluate current benefit program designs, pricing, and funding arrangements to determine the appropriate level of coverage and cost.
• Advise areas of concern or gaps in coverage and present new benefit products that could enhance the benefits package to your executive Team.
• Review detailed claims analysis by plan to develop optimal actuarial formulas to present to the market.*
• A meticulous review of each large claimant for the current plan year with the most accurate and current updates on each insured.*
• Develop Bid Specification and incorporate it into our comprehensive, carrier-acclaimed electronic RFP.
• Analyze providers based on the RFP responses.
• Negotiate rates and benefits to meet the objectives and achieve the best possible combination of price and benefits from each carrier.*
• Review prescription drug and provider disruption analysis.
• Negotiate agreements and final rates with selected providers.*
• Provide market survey data.
*Wilson Benefits spends much more time on these crucial steps than competitors. We spend 10 to 12 weeks on these processes, and the financial results are unparalleled.
• Overall service and quality.
• Experience in administering network-based programs.
• Commitment to continuous quality improvement processes.
• Effective administration procedures (e.g., coordination of benefits, subrogation, etc.).
• Vendor responsiveness to the group representatives and employees.
• Customer service access for claim and eligibility issues.
• Cost efficiency.
• Willingness to adapt to special terms and conditions.
• Willingness to provide wellness programs and support client initiatives.
• Adequate disease management and cost containment program.
• Superior network coverage concerning employee locations, utilizing your specific network utilization reports.
• Network discounts in specific zip codes.
• Adequate employer and employee Web-based services.
• Update your online enrollment portal with all updated benefits, rates, and pertinent information.
• Coordinate transition between insurance companies, including the emphasis on transitional care for individuals with ongoing medical issues.
• Provide open enrollment materials, including custom PowerPoint presentations, benefit enrollment guides, and enrollment forms.
• Provide legally mandated materials.
• Build and update the online enrollment portal for employee’s current elections and benefit coverages.
• Coordinate activities regarding employee benefits programs, including medical, dental, vision, life, disability, voluntary products, and wellness initiatives.
• Conduct open enrollment meetings.
• Prepare and submit eligibility/enrollment files to insurance carriers at renewal and generate group paperwork.
• Final enrollment reconciliation to assist with payroll deductions.
• Wilson Benefits does all the day-to-day plan administration, including insurance carrier updates, and maintains online enrollment portals at open enrollment and throughout the year.
• We process all new employees and their elections with each insurance carrier throughout the year.
• We process all terminations and Cobra offerings with all insurance vendors throughout the year.
• We facilitate all off-cycle benefit election changes with each carrier throughout the plan year.
• Conduct monthly bill reconciliation to your payroll deductions and coordinate with HR.
•Review and correct benefit contracts, certificates of coverage, SPD’s and SBC’s for accuracy with each carrier and coverage.
•Review recent claims overview and other pertinent benefit data throughout the plan year with the Executive Team and other benefit personnel.
•Resolve all claims situations that may arise with same-day responses most of the time.
•Act as a Liaison for employees regarding claims, billing, and any benefit issues. Intervene with providers on the employee’s behalf. They often deal directly with employees.
•Provide resources and quick responses to all inquiries from management AND employees.
•Consult and assist with HR regarding dependent eligibility audits.
•Conduct new employee orientations.
•Provide your company with our comprehensive HR portal resources at no additional cost. This includes answering HR-related questions, the latest forms, handbooks, wellness campaigns, etc. It is a Human Resources portal, not just a benefits portal.
•Wilson Benefits provides a Human Resources Hotline at no additional cost. You have unlimited access to HR advice from a team of qualified HR professionals backed by ERISA attorneys. Our top-rated HR portal also let's you create an online employee handbook that auto-updates there are any new laws in any state. We assist you with this as well.
This same portal has a complete library of learning management systems which you can track who watched the video, and we can create custom training videos as well.
•Conduct advanced claims analytics to drill down on problem areas and assist in future benefit plan design specifics with our team of experts.
Wilson Benefits provides you with our comprehensive HR Portal resources at no additional cost. These include answering HR-related questions, the latest forms, handbooks, wellness campaigns, etc. It is a Human Resources portal, not just a benefits portal.
Your client portal provides you access to valuable benefits and HR resources, including the following:
• Legislative information updates and forms to help you comply with COBRA, HIPAA, FMLA, health care reform, Medicare Part D, and other benefit and employment laws.
• Workplace wellness program support.
• Employee benefits communication pieces.
• Employee health and wellness resources.
• Employee and employer newsletters.
• Community forum with access to thousands of benefits and HR peers nationwide, allowing you to share information and seek answers to complex questions or situations.
• Access to employer survey results on significant benefits topics.
• Extensive links to relevant benefits, health care, HR, legislative and wellness resources.
Compliance
• Effective administration procedures (e.g., coordination of benefits, subrogation, etc.).
• Vendor responsiveness to the group representatives and employees.
• Customer service access for claim and eligibility issues.
• Cost efficiency.
• Willingness to adapt to special terms and conditions.
• Willingness to provide wellness programs and support client initiatives.
• Adequate disease management and cost containment program.
• Superior network coverage concerning employee locations, utilizing your specific network utilization reports.
• Network discounts in specific zip codes.
• Adequate employer and employee Web-based services.
• Wilson Benefits provides resources, forms, and hands-on assistance with all HR compliance items, such as ACA, Cobra, Section 125, ERISA, Medicare Part D, FMLA, ADA,etc.
• Provide ongoing education and compliance assistance with state and federal mandates and notices.
• Assist with non-discrimination testing.
• Guide and support you with all compliance requirements and questions.
• ACA training and assistance with 1095 reporting.
• Serve as resources and members of the Wellness Committee.
• Liaison for wellness programs at your and insurance companies.
• Advise and help design your wellness initiatives.
• Recommend vendors for your Wellness events.
• We track all Wellness Initiative results and will provide you with ongoing activity.
― Zig Ziglar
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