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In today’s market, large group health insurance is defined as having 101 eligible full-time employees. Most insurance companies have different processes, procedures, and admin platforms for companies with over 100 employees. Typically, there is a separate customer service department, sales representatives, and underwriters. Even a fully insured client will have access to some claim reporting that would include healthcare utilization reports, prescription usage, & diagnosis information. Also though 100+ employees are considered a large group, some in the large group health insurance field view 300+ employees as a true large group.
When it comes to your health insurance, you should go with an Indiana Health Insurance Agency you can trust, and use Nefouse & Associates!
Creating RFPs for a large group can be a timely process and can start up to six months before the renewal date. Companies, with over 1,000 employees may start the process a full year in advance. The insurance will request a significant amount of data before releasing a proposal. Employee census, summary of benefits, summary plan document, claims data up to three years, current renewal rates & renewal data.
A few carriers will underwrite the case and issue firm rates based on a member-level census. The member-level census lists all the members on the plan, their birthdates, and zip codes. The insurance carriers will then use this information to run a utilization report on RX usage. This information provides underwriting with diagnosing information & drug utilization that illustrates the risk for the group. This same member-level census then can be used for the installation of the new group health benefits. This streamlines the quoting and installation process.
In today’s market, there are not that many large group health insurance companies left. Through merger and acquisition, there really are less than five. In central Indiana, Anthem, UnitedHealthcare, and Cigna are the main large group carriers for both fully insured and Administration Service Only (ASO) which is a self-insured large group health plan. There is currently one regional carrier through IU Health plans that offers an HMO hybrid. Southern Indiana includes Humana, and there are multiple third-party administrators (TPA) throughout the state that will administer a self-funded plan.
The reality with few companies offering traditional fully insured and ASO plans in the state, those carriers probably already have data on your group.
Determining the best large group insurance carriers from both a regional and national level for each company.
Consult on the advantages and disadvantages of each option and if the group is a good candidate for being self-insured.
Review of client claims data on both medical and pharmaceutical.
We will take the current large group insurance benefits out to market by creating a request for proposal (RFP). This is a complete evaluation and negotiation of insurance proposals on the client’s behalf.
Benchmark existing group health plan design against similar sizes and industries on both a regional and national level.
Oversee the communication of all data to the insurance company for new enrollment and renewal.
Deliver resolutions for any ongoing claims or administration issues.
Deliver resolutions for any ongoing claims or administration issues.
Assist with communications to educate employees on group benefits and wellness.
Here at Nefouse & Associates, we have been online since 1999, and we have become very familiar with why a group may come to the Internet for group health insurance information or proposals.
Top 9 Reasons Why a Large Group Goes to the Internet for Health Insurance:
Over the years, we have delivered large group health insurance solutions for all these reasons listed above. If you have arrived at the web and need direction on what options are available, we can help.
At Nefouse & Associates, we pride ourselves on the ability to negotiate on behalf of our clients. We excel in the large group arena. A large group is defined as an employer with 50 or more full-time employees. Not only do we deliver the best personal service, but we provide the best rate. Our dedication to cost reduction can lead to hundreds of thousands of dollars worth of savings over time. In groups of more than 1,000 people, clients realize they have millions of dollars in savings.
Group health insurance changes significantly when providing for a large group. One critical change is access to claims. Having access to claims can speed up the underwriting process when going out of the market, which is essential every few years to keep down premiums. Nefouse and Associates excels at finding cost-savings in the large group market, which can lead to reduced expenses for the employee and employer.
When a company reaches more than 200 employees, additional group health insurance vehicles become available. Groups can look at fully insured plans but also entertain self-funded options. Nefouse and Associates has achieved tremendous success negotiating with carriers for large group business. The savings we deliver in this step of the process result in significant savings for the company. Groups with more than 500 employees have market access to additional options for both self-funded and ancillary products.
Contact Nefouse & Associates, an Indiana Health Insurance Agency, today to find out how we can help your group reduce costs.
