Question

3. Discuss the most common claims and benefits administration problems, their repercussions, and how to identify and rectify them. 4. Discuss how the Patient Protection and Affordable Care Act (ACA) has affected the formal appeal review processes.

Answer 1

Employee benefits are integral to the success a business. Without comprehensive benefits, it becomes much more difficult for employers to attract and retain highly qualified employees. A competitive benefits package includes a number of plans, including health, dental and vision insurance, life insurance, disability insurance, a retirement plan, and potentially even more options.

1. Compliance:

There are minimum standards companies must meet when offering certain benefits. Compliance is a beast to contend with. There is no room for error—and if you make a mistake, you could invite possible litigation.

2. Time Management:

Running a benefits program is time intensive. Businesses may have five or more vendors to manage for things like onboarding, termination, life changes, employee questions, annual renewal reviews, and voluntary and required communication. Additionally, systems and processes need to be in place in order to manage all the information effectively. If benefits plan administration isn’t your company’s forte, then you will have a steep learning curve.

3. Healthcare Cost:

Healthcare costs are rising every year, and you have many things to consider. Do you share more of the cost with employees, lessen the benefits, reduce your workforce, or choose cheaper options? Or perhaps you’re considering adding wellness programs and health savings accounts. No matter what you’re faced with, thoroughly vetting all of your options and finding the right insurance that doesn’t hurt the bottom line is challenging.