How do we get started?

How Do I Change Administrators?

What About Large Claims?

How Do I Select an Administrator?

Why Choose Penn Western Benefits?

THE DECISION TO SELF-FUND 

A self-funded health care program, when compared to fully insured, minimum premium, and Health Maintenance Organizations (HMO’s), provides many attractive benefits.  Self-funding means the employer assumes payment of eligible health claims until per-employee and company maximum amounts are reached.  When claims exceed these pre-determined levels, excess-loss coverage reimburses the employer, thus limiting the employer’s liability.

Because of the “pay as you go,” variable-cost nature of self-funding, savings can be substantial when claims experience is favorable.  Also, the client, not the insurance carrier,  receives maximum benefit from cost containment efforts. These savings can increase a company’s profitability and competitive position.

 Other meaningful benefits provided by self-funding are greater control over plan design and freedom of provider selection.  Health care plans can provide unrestricted access to providers  regardless of any provider affiliations in cost containment organizations. This is an  important consideration in all markets, especially in less-populated areas where penetration of these organizations is low.  An employer may also include cost containment measures such as pre-certification, case management, and preferred provider organizations. Employers retain maximum freedom in plan design, gaining the optimum balance of provider selection, access,  quality, cost sharing with employees, and cost containment.

 Self-funding a health plan with Penn Western Benefits provides the following additional benefits:

·        Greater feedback on plan performance.

·        Reduced state premium tax.

·        Plan changes implemented quickly and easily.

·        Improved claims administration.

·        Avoidance of state-mandated benefits.

·        Thorough, periodic information on plan expenses.

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CHANGING ADMINISTRATORS

As the popularity of self-funding has increased, the services and capabilities of third party administrators have become more important.  Because health care benefits are a significant expense for every employer, companies have always relied on their TPA for proper handling of claims.  As the health care industry has become more complex and competitive, companies look to their TPA as a source of guidance.  Objective evaluation of benefit plan structure, options, and provider networks is an area where PWB adds significant value.

Penn Western Benefits views our role as an extension of our clients’ Human Resources department.  We deliver accurate, timely services, sound counsel, and as much feedback and interaction as our clients desire.  Making every interaction with clients or their employees pleasant and courteous is our ongoing desire.

Employers have discovered there are significant differences among administrators.  Inattentive service, unsatisfactory communication levels, or a lack of professionalism have caused some employers to lose confidence in their administrator. If you are self-funding but your administrator is not delivering the ingredients we describe, Penn Western Benefits may be the solution.  Administrators can be changed at any time, and our experience and expertise in this area make changing administrators effortless for employers.

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EXCESS LOSS PROVIDERS

PWB, because of our size, market activity, and superior reputation, deals with a large cross-section of excess loss providers and enjoys excellent relationships with these companies.  We are very selective when choosing excess loss providers due to the important role they play in a successful self-funded plan.  Their financial soundness (A rated by A.M. Best or higher), competitive cost and quality service are our most important requirements. 

PWB obtains competitive quotes for excess loss coverage at each  renewal to assure that clients receive the most competitive cost and   full benefit from changing market conditions.

NOTE:  A++ and A+ are defined by A.M. Best as “superior financial strength and ability to meet policyholder obligations.”  A is defined as “excellent financial strength.”

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SELECTING AN ADMINISTRATOR

 Major factors to consider when selecting a Third Party Administrator (“TPA”) include the following:

• QUALITY OF SERVICE.  A TPA representative should be available for employee meetings, employer updates, discussions on legislative and regulatory developments, discussions on new services and health care trends, and solving any problems related to the plan.  Client references should be readily available.

 ·       EXPERIENCE.  Closely related to quality factors is the experience level of a TPA  staff.  The experience and knowledge of day-to-day contacts, typically claims, administration, and service associates, are key to a successful TPA relationship.  PWB associates average almost 20 years’ industry experience.

 ·        CLAIMS PROCESSING ACCURACY.  Errors in claims processing and paying bring about significantly higher expenses for an employer.  Duplicate payments, payment of ineligible claims, failure to file excess loss claims, and incorrect payment amounts are all problem areas that unnecessarily cost employers.  PWB pays claims with an accuracy rate of over 99%, based upon internal audits and those performed by excess loss carriers.  Periodic examinations by independent Certified Public Accountants verify our achievement of accuracy expectations and  consistent application of claims payment procedures.

 ·        CLAIMS MANAGEMENT PROCEDURES.  Employers should evaluate a TPA’s Claims Management practices, which track health care services use, indicate cases in need of large case management, and help identify problem areas and abuse.

·        COST.  Cost is an important consideration, and Penn Western Benefits is very competitive in this area.  Administrative fees are established  on a per-participant basis, giving consideration to the number of participants, number of locations served, and other factors. 

·        REPORTS.  A TPA should be able to provide eligibility reports, paid claim analysis reports, and other reports, custom-designed for the client, on at least a semi-annual basis.

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WHY SELECT PENN WESTERN BENEFITS?

Penn Western Benefits firmly believes that self-funding in partnership with a quality third party administrator is the ideal solution to rising health care expenses for many employers.   We are one of the finest, most progressive TPA’s available.  In addition to quality service, our customers expect and greatly value the high degree of sensitivity, caring, and knowledgeable professionalism that we deliver.  This service enhances an employer’s image to its employees, which can strengthen the employer's competitive position.  Self-funding's options, combined with a high level of service, make Penn Western Benefits a very attractive addition to your company’s group of business partners.  

Thank you for the time you have taken to learn more about Penn Western Benefits.  If you have questions or would like to learn more about our services, please contact a marketing representative at (336) 665-9400.  We would like the opportunity to explore a relationship with your company soon.