Smith Administrators | Health Risk Managers

By: Smith Administrators  09-12-2011
Keywords: Insurance, health care, medications

Services

Smith Administrator’s high level of service is clearly tied to the products we administer. The following is a look at some of the plans we manage and the services we provide in conjunction with those products.

Self-Funded Benefit Plans
Self-funding began as an innovative way for employers to reduce costs and exercise greater control over how plans are defined and administered. It approaches benefits as budgeted expenses, and helps businesses avoid the high overhead and administration costs associated with coverage by an insurance company.

A self-funding company decides upon a plan of benefits and a fund is established for coverage up to a predetermined loss level. Stop-loss or excess-loss insurance is available to protect the plan and the employer against extreme losses. The most common self-insured plans cover medical care, dental benefits, short-term disability and vision.
One of our goals is to help you understand the options so you can make informed decisions regarding your benefits program. Smith Administrators can help determine if self-funding is right for your business, based on many factors including your company size, claims history and age of employees.

Smith Administrators can prepare your plan document, detailing plan provisions and eligibility. We'll prepare employee benefit descriptions, identification cards, ERISA reports and other necessary materials. On your behalf, we will negotiate favorable stop-loss rates and terms, maintain funds for claim payments, pay claims and prepare necessary claims and government reports.

Flexible Benefit Plans
Smith Administrators offers comprehensive flex plans. Such plans can offer employers and employees considerable tax savings and other advantages. Employees and/or employers can deposit pre-tax dollars into a flexible spending account to pay certain health and related expenses not covered by medical insurance. Sometimes referred to as cafeteria plans, let each employee elect an annual dollar amount and choose services to be covered from a menu which may include various group medical insurance premiums, out-of-pocket medical expenses and dependent care expenses. Also, Over-The-Counter medications may now be reimbursed.

Smith Administrators helps companies install flexible benefit plans meet the requirements of Section 125 of the Internal Revenue Code. We educate and inform employees through newsletters and individual account reports. We administer the "flex" funds in accordance with federal regulations, and keep detailed records on behalf of the company and the employee. We place priority on processing claims, and reimbursing the employee promptly.

Rx Card Benefits
Smith Administrators offers an array of services to meet the goals of cost containment, multiple pharmacy access and quality services for members. The pharmacy benefit methods used include: prescriptions filled at designated (or network) pharmacies, adherence to drug formularies, out-of-pocket incentives for generic drugs and mail order services for chronic use medications.

HRAs
An HRA is a Defined Contribution health care vehicle, also called a defined contribution (DC) health plan. It is solely an employer-funded vehicle. HRAs cannot be funded by employee dollars.

iHealth/WellMetrix
Smith Administrators utilizes a health management program called iHealth.  This program provides useful, pertinent and reliable information for the purpose of pro-actively improving one’s overall health status.  Early intervention is the key for many diseases.  This program provides a multi-level approach designed with your budget in mind.

Wellmetrix is our onsite health screening unit.  We come onsite and test for multiple health risk factors and in turn provide those to the employee.
These 2 programs work hand in hand to maintain your employees overall wellness which can greatly affect health benefit costs.

Services
We believe the employer is entitled to prompt and accurate attention, and that the individual plan participant deserves the same focus on his or her health and financial needs.

Our willingness to work on behalf of the client and the participant has been demonstrated time after time. We are highly proactive in negotiating bills for the employer, the plan and the employee. Our strong relationships with health care provider networks and medical facilities give us an edge in accessing centers of health care excellence to meet the needs of the patient, while saving the plan and the individual money. We negotiate so all details are handled reasonably and fairly.

Specific services provided by Smith Administrators include benefit plan consulting, claim processing and reporting, claim accounting, coordination of Medicare benefits, benefit plan compliance, Section 125 administration (flex plans), managed care coordination, mandated benefits administration, network repricing, risk management, reinsurance underwriting, reinsurance intermediary services and many others related to benefit management.

ERISA Compliance Assistance
The Employee Retirement Income Security Act of 1974 set standards for administering private employee benefit plans to protect the interests of people who depend on the benefits. Smith Administrators assists employers in meeting ERISA rules, including disclosing financial and other information to participants and beneficiaries and complying with reporting requirements. We process claims and assure that benefits are set up and managed according to ERISA.

HIPAA Administration
The Health Insurance Portability and Accountability Act of 1996 made changes to group health coverage rules that affect disability extensions, pre-existing condition limitations and coverage of newborns and adopted children. Subsequent regulations addressed claims and appeals, privacy, security and standardized electronic transactions. Smith Administrators assures that these rules are fully incorporated into HIPAA administration.

COBRA Administration
The Consolidated Omnibus Budget Reconciliation Act of 1985 mandated the continuation of group health coverage for qualified terminated employees and their covered dependents. Smith Administrators assists clients by sending continuation notices to the qualified beneficiaries; coordinating enrollment, coverage and eligibility; administering billing; receiving premium payments; and handling a range of related details until the individual is no longer covered under COBRA.

Plan Design
Strong planning and execution can assure not only the monetary success of your program, but also its enthusiastic acceptance by your employees. We develop custom plans including benefits and features that your company managers believe are meaningful and will meet the needs of the employees. Here, we help you sort through the maze of HMOs, PPOs and insurance companies and creatively design a plan that is valuable to you, the employer, and the plan participant. Plan design includes developing necessary plan documents and summary plan descriptions.

Keywords: Employee Benefit, health care, Health Care Provider, Insurance, Medical Facilities, medications

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