Life & Health
Life and Health Plans
The lifeblood of Premier Health Advisors organization, life and health plan consulting represents over 70% of the company’s business.
Our expertise is rooted in over 50 years of combined professional experience which has been applied to the management of public and private industry plans since the early 1980’s. The company has been consistently sought for comment on the development of the life and health business by the consulting, agency and insurer communities alike.
We offer leading edge advisory services and with the advent of our Enterprise Health practice and reporting suite, are once again demonstrating leadership in this ever important area of business. As double digit inflation places inordinate pressure on the very survival of these life and health programs, Premier Health Advisors is the logical choice to look for solutions.
Group Life and Health programs are mainly funded in two ways; under insured and self insured contracts. They typically renew once per year when the insurer attempts to set new costs based on what they deem necessary to fund the program. Premier Health provides its customers with a renewal report that outlines the insurers requested financial action, our audit of that action and resulting negotiations with them.
Under the insured type of plan, an insurer determines a price for policyholder to pay that best covers the expected claims, insurance risk, taxes, reserves and their expenses to administer the program. Under a self insured program, the client pays for the claims that are adjudicated and found to be eligible and paid to the members of the plan along with applicable taxes and administration fees.
Premier Health Advisors has a history of delivering effective pricing due to its superior underwriting and negotiation skills with the insurers who offer these programs. Clients of Premier Health can find all renewal reports in their entirety, securely posted to this site.
The Financial Experience Report is the measure of performance of the plan in total and the individual benefit streams. It is important to measure the relationship between premiums and paid claims to determine effectiveness of the plan and corporate benefit expenditures in total. We report premiums paid and cash claims by line of benefit.
For self insured plans, claims paid on a budget versus actual basis can determine whether the cost centre is in a surplus or deficit position. We report actual claims versus budgeted to help sponsors determine if they are in a budgetary surplus or deficit. Trends exhibited in claims experience can provide key indicators to the future costs for life and health programs for the employee population.
Premier Health provides its clients with quarterly updated experience results for both insured and self insured programs and forecasts for the next financial renewal date based on the most recent results posted.
Contracts represent the legal agreement between the insurer/administrator and the plan sponsor. It itemizes when, how, and to what degree, claims will be reimbursed to the member.
For ease of understanding and reference, we post all client contracts to the secure site for quick reference. All amendments are posted by removal of outdated clauses and insertion of new clauses that apply.
This is meant as a guide and should there be a discrepancy between what is posted to the site and what is found in the insurer record, the latter will apply.
Often clients require specific tasks be completed on the status of their benefit programs. This may include plan design change reviews, financial forecasting, peer review and or many other types of assignments. All reports are posted to this site, titled and filed chronologically for your review and reference.
Guidance for Plan Sponsors
Every year in December, Premier Health Advisors completes a Guidance Presentation for client sponsors. In this report, we comment on what has transpired over the past twelve months as well as what is slated or expected to occur in the foreseeable future. For example, it provides plan sponsors in various jurisdictions changes in tax regulation as it pertains to benefit programs, new offerings by the insurance industry, news as it relates to the reorganization of the provider networks as well as much more. This section is also used to post links to useful sites that sponsor should visit for additional information.
Health Spending Account (HSA)
A Health Spending Account (also referred to as a flexible spending account) is a recognized method of reimbursing an employee for CCRA approved health care expenses outside of a normal contract of insurance. Employers sometimes allow employees to deposit premium dollars into a flexible account which can be used to pay for expenses that normally wouldn’t be covered by the employer program. For employees that have high dental or health costs or where there is a significant deductible in any line of benefit, this account can be used to defray additional expenses not normally covered. More recently, employers are expanding the approved list of HSA expenses to include buy ups for more vacation credits, elder care expenses, additional retirement deposits as well as many other expenses. There are rules regarding the use and taxability of such accounts – Premier Health Advisors can assist you in determining if a HSA is right for your business.