HDM can help you minimize BOTH the cost and risk of health benefits. Employers spend over $7,000 per employee per year on health benefits. Any overspending immediately multiplies by the size of your workforce, and that larger number comes right off the bottom line.
The self-insured health plans adopted by most medium to large employers are cost-effective, flexible and provide more control than traditional indemnity coverage, but the very name "self-insured" implies that greater financial risk.
You can Outsource Administration, But Not Responsibility
The vast majority of employers outsource plan administration to Third Party Administrators, Pharmacy Benefit Managers and/or Dental Plan Administrators. These vendors do the complex and error-prone work of plan administration, claims administration and financial reporting, but you are responsible for their results.
| Risks of outsourcing administration include: |
| . Payment of claims may not be made according to your SPD |
| . Internal controls of TPAs and PBMs |
| . Relying on policies/procedures of TPAs and PBMs and their cost implications |
| . Discrepancies in funding |
| . Lack of stop-loss management resulting in overpayments |
| . Recovered overpayments may not be credited to your account |
| . Weak subrogation monitoring may increase your exposure |
| . Contracted care management services may not result in ROI |
Examinations of these and other issues through HDM's BenefitsAudit have uncovered and generated recovery for overpayments and future savings in the millions of dollars.
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