Large Group

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 report, prescription usage, & diagnosis information. Also though 100+ employees are considered a large group, some in the large group health insurance field view 300+ employees is true large group.

Request for Proposals:

Creating RFP’s 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 off a member level census. The member level census, lists all the members on the plan, birthdates, & zip code. 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 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 acquired there really is less than five.  In Central Indiana, Anthem, UnitedHealthcare & 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 offer an HMO hybrid.  Southern Indiana includes Humana, and there are multiple Third Party Administers (TPA) throughout the state that will administer a self-funded plan.

The reality with few companies offering traditional fully insured & ASO plans in the state, those carriers probably already have data on your group.

Nefouse & Associates Lager Group Services

  • Carrier Evaluation: Determining the best large group insurance carriers from both a regional and national level for each company.
  • Self-Insured VS Fully Insured: Consult on the advantage and disadvantage of each option and if the group is a good candidate for being Self Insured.
  • Claims Assessment: Review of clients claims data on both medical and pharmaceutical.
  • Plan Design recommendation: Benchmark existing group health plan design against similar size and industry on both a regional and national level.
  • Request for Proposal Creation: We will take the current large group insurance benefits out to market by creating Request for Proposal (RFP).  This is a complete evaluation and negotiations of insurance proposals on the client’s behalf.
  • Installation: Oversee the communication of all data to the insurance company for new enrollment and renewal.

Benefits Administration: Assist with choosing a benefit admin platform or admin platform.

On-Going Services:

  • Service with the carrier:  Deliver resolutions for any ongoing claims or administration issues.
  • Employee Communication: Assist with communications to educate employees on group benefits and wellness.

 

Why Large Group Comes to the Internet for Info

Here at Nefouse & Associates, we have been online since 1999, and we have become very familiar with why a group may come to the world wide web for group health insurance information or proposals.

Top 9 Reason, a Large Group, goes to internet for Health insurance.

A company goes from small group to large group in one year and receives a significant renewal increase.

If a company merges or acquires another business and now they are over the 100-employee threshold.

The group health plan just lost a significant risk factor and now is marketable.

The group is self-Insured and has experienced a lasering and now would like to entertain fully insured.

A new controller is now in charge of HR with little experience in benefits.

A group has experienced services related issues with representation or the insurance company and sometimes both.

A company is part of a multi-employer welfare association (MEWA) and wants to know if they are better off obtaining health insurance outside the MEWA.

The company is a nonprofit or municipality and is required to create an open request for proposal from brokers/Consultants.

Organizations have gone directly with a fully insured carrier or a TPA without broker representation.

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 option are available, we can help.

Large Business

At Nefouse and 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 can realize the 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 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 results 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 today to find out how we can help your group reduce costs.