8 Questions You Should be Asking Your Benefits Advisor… Continued

Are you paying your benefits advisor for activity or for results? Are you paying them to administer your plan or to control your costs? There are eight questions you can ask to find out. In the previous article, I shared with you the first four questions. Here are the next four.


5.  What do you do to manage my company’s health insurance renewal?

Is your group health insurance renewal being shopped only to fully insured carriers every year? Or do are the only self-funded option you review have an insurance carrier as the Third Party Administrator (TPA)? If so, you are missing your opportunity for budgetary control.

A proper proposal can only be delivered if can provide complete claims details. It used to be hard to get those… not anymore… and even if your company doesn’t want to give them to you (shhh –it’s a secret, but we can leverage all the claim info now…even for a small group)

Are you regularly hearing about strategies to ensure all vendor interests are aligned with yours, rather than with one another? What about that all vendors have fiduciary responsibility to you, and that you have full and transparent access to claims data? If not, ask why?


6.  Are you showing me both bundled and un-bundled self-insurance solutions?

If you are an employer of less than 25, this point may not apply to you; however, you can still get accurate claims data so you can negotiate more effectively or decide if you need to move on to another solution.

There are ASO self-insured plans, and then there are self-insured plans. If you are self-insured on an administrative services only contract with an insurance carrier, you are not managing your plan. All you are doing is managing your cash flow.

The only way to control the cost of healthcare is to control the cost of healthcare. If you can’t do that, you can’t manage your costs long-term. For example, if you’re ASO-insured with a big carrier, all you can manage is your cash flow. However, there’s plenty more that you can do if you move to an independent TPA with un-bundled solutions, including fiduciary responsibility to you, and with complete access to data.

When you have that, you can start to layer in all those cost containment tools we teach you about -direct primary care, direct contracting, bundled pricing, care assistance, and 24-hour advocacy. All of these can be built in –quickly or over time -and you can start to control the costs of care and make the plan work better for your employees.

Have you been told that your business is not large enough to be self-insured or to consider a self-funding option even if you have 100 employees or more? That is simply not true. You are large enough to consider it, understand how it works, and manage the financial implications of what a self-funded plan is. It’s just not as complicated or as risky; oftentimes, it is less risky than you’re being told.


7.  What approaches do you recommend to encourage my employees to be great consumers of care?

So often employers forget that employees are their first line of defense. They have budgets too and don’t want to spend any more than they have to. Not to mention, they want high quality care for themselves and their families.

It’s not easy to be a good consumer of healthcare resources. So, what are you doing to help them? There are some excellent budget-friendly tools for that, which prove their value year over year. Plus, they’re a fixed cost, and seldom increase.


8.  What are your most effective solutions to incentivize my employees to participate in their spouse’s health care plan?

This question is more for your employees’ spouses. If you can incent or penalize your employee to move onto their spouse’s health plan, then that risk is removed from your plan, which is the least risky strategy.

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