Revising Administrative Processes for a Large Multi-State Client

Benefits Case Study Human Resources Insurance Life Insurance

Companies and organizations spread across multiple states and jurisdictions frequently face an increased number of rules and regulations when compared to a single-site employer group. Many companies experiencing fast growth into new territories must adapt to remain compliant with state and federal law to maintain sustainable hiring and HR practices. Lacking HR support and falling out of compliance can result in lawsuits, fines, or claims worth hundreds of thousands of dollars. Thus, it is pivotal in today’s business environment to implement HR best practice into all facets of operations.

Recently, Summit began working with an employer group in the healthcare industry whose employees are spread across multiple states in the Midwest. Having experienced a high rate of growth in just a few years, the group’s current benefits strategy was quickly becoming financially unsustainable. The group was on a trajectory for significant rate increases due to high claimants within their plan. Additionally, information about newly acquired employer subgroups that had been enrolled in the plan had not been fully disclosed to the health insurance carrier, and numerous employees had not been enrolled in the employer-paid benefits. These both created additional liability for the employer. Finally, failure to report employee terminations with the carriers in a timely manner was resulting in thousands of dollars of overpaid premium.

Summit’s Solution:

The Summit team was immediately able audit the plan, identify and address problems, and create a strategy for solutions. First, we utilized carrier relationships to resolve the eligibility issues that had occurred.  Credits were issued to the group for any overpaid premium, and employees missing from the employer-paid benefits were enrolled in the required coverage. In response to previous negligence to properly report enrollments and terminations to carriers, a process was installed to ensure that every eligibility change was reported and documented timely and correctly. Now, all required eligibility changes would be processed according to the plan contract and the group would remain compliant with all state and federal regulations.

Finally, to address and fix the premium increase that the group was facing, Summit explored and priced alternative funding methods, considered all viable carriers, and evaluated various plan funding methods to see how the group could create savings within their plan. While working diligently over the next year to position the group for more favorable underwriting, Summit also resolved the issue of improper coverage for the subgroup.  Once the reason for their prior-year rate increase was identified, Summit restructured the group’s plan to optimize underwriting.  Following the 42% rate increase from the previous year, Summit’s restructuring of the plan brought the renewal down to a rate decrease the following year, while simultaneously improving the benefits and maintaining the same high claimant membership. The group reduced the overall cost of their benefit package by over 10% following the transition, which created over $177,000 in total savings.

Shelby Robertson

Senior Account Manager

These Results Are For Illustrative Purposes Only And Should Not Be Deemed A Representation Of Future Results. Circumstances, Solutions, And/Or Results Are Based On Specific Facts Tied To Unique Client Situations. Favorable Results Cannot Be Guaranteed Even In A Similar Scenario. Each Specific Set Of Circumstances Will Differ Depending On Client Needs And Profile. Actual Results May Be More Or May Be Less Than Those Shown. Past Performance Does Not Guarantee Future Results. This Assessment Is That Of The Writer, And Not The Recommendations Or Responsibility Of Cetera Advisor Networks LLC Or Its Representatives.

Shelby Robertson is not affiliated with Cetera Advisor Networks LLC.