Plan Design and Development is our Expertise

First things first. To begin with, we'll work closely with you to establish your organization's unique health benefit plan requirements and objectives. Based on the outcome of our discussions, we'll recommend one of the following approaches:

• Administrative Services Only (ASO) Plan: For a fixed administration fee, an ASO plan allows the plan sponsor to pay only for actual claims submitted by members and dependants, making it a cost-effective solution.
• Traditional or Blended Plan: Working closely with a number of insurance partners, we also administer traditional insured group health benefit plans, as well as non-ASO elements of group benefits plans, such as Out of Country and Travel Assistance, and Stop-loss coverage.

Once we've agreed on the right approach, we'll put together a customized plan, strategically incorporating some or all of the elements below, depending on your needs:

• Pharmacy and dental provider network management
• Specialized plan design options, such as sliding or tiered co-pay and annual deductibles, customized formulary creation and maintenance, varied dental fee guide options, and grouping of dental categories with variable maximums, deductibles and time definitions
• Health Service Spending Accounts (HSSA)
• Comprehensive billing and invoicing system that features wallet certificates, monthly premium billing statements, claims management services, life and disability plan administration, and premium remittance
• Flexible and actionable reporting package that includes a suite of comprehensive printed reports, in-depth electronic reports, and user-defined customized reports

Once the plan has been developed to your satisfaction, we'll provide you with health benefit cards or health benefit key tags for your employees. Desktop and smartphone users will also be able to register and receive electronic health cards from their secure Member eProfile^™ account, which they can print out or store electronically for display upon purchase. That's it! Plan members are now ready to submit claims.

Our clients count on us to save them time and money. Beyond numbers and metrics of performance, this requires a relationship built on trust. That's why we're committed to providing exceptional account management.

Our account managers are subject matter experts and excellent communicators with advanced training and strong problem-solving skills. As such, you can count on them to alleviate any headaches that might otherwise arise from the administration and management of your employee benefit program.

As a ClaimSecure client, you'll be designated a dedicated account manager who will consistently support your needs as you work through every phase of plan development and execution – and we'll keep in touch with you along the way to make sure you're being served to your satisfaction. All account managers receive twice-yearly report cards and reviews and their remuneration is a direct reflection of their performance, so you can be sure they're motivated to exceed your expectations!

Analytics are key to ensuring the long-term success of any health benefit plan. Taking a collaborative approach, our highly skilled analysts will design a custom analytics solution to turn your data into actionable and timely information that will help you address specific business needs. If you have questions, we're ready to help!

ClaimSecure's auditing functions are designed to verify claims integrity and ensure contractual compliance. Through a series of comprehensive procedures, we deter, detect, investigate and resolve abuse and fraud.

Committed to providing accurate claims management and adjudication services is paramount to us. As a result, we never rest on our laurels. Continuous improvement in this area is an objective of every ClaimSecure department.

• Internal Audits

  Every core task within our organization is audited for accuracy and completeness. Every department has established turnaround times and standards. Likewise, every department is tasked with maintaining detailed policies to ensure that sound processes are in place for verification, tracking and reporting purposes. These detailed policies are stored in a dedicated area of the system for easy retrieval and for disaster recovery purposes. The standards are approved corporately and are monitored on an ongoing basis.

• External Audits

  We analyze claims data by providers and groups, as well as at the member level, to identify anomalies, growth, trends and deviations in claiming patterns. Tagged claims, providers and claimants are audited by one of our Special Investigations Unit team members.

In the event auditing reveals any discrepancies, ClaimSecure refunds 100% of recovered dollars back to our clients.

For your convenience, we offer two unique billing methods. Whichever you opt for, rest assured that we'll work with you to customize a financial model that suits your needs.

• Bi-weekly Invoicing

  A bi-weekly invoice is issued to clients who elect to have some or all of their benefits managed under an Administrative Services Only (ASO) financial model. Typical benefits covered under this model include drug, dental and extended healthcare services. With this option, a deposit is collected prior to the effective date of coverage and the client is issued a bi-weekly invoice based on actual member claims processed and/or paid during the two-week period, plus administrative fees and applicable taxes. Under this arrangement, clients are only invoiced for actual usage of the program rather than a flat monthly premium.

  • Invoicing option #1: Budgeted Administrative Services Only (BASO)

    Clients who prefer a more consistent monthly payment model can implement a Budgeted ASO program. Under this arrangement, clients are invoiced a flat monthly dollar amount that is consistent from month to month (e.g. $10,000) to provide for better internal cash flow management. Financial reconciliation of payments versus actual incurred claims is performed in accordance with an agreed-to cycle and surpluses and/or deficits are addressed at that time.

  • Invoicing option #2: Level Payment Plan (LPP)

    The LPP has been designed for clients who prefer a funding model that best replicates a fully insured program. Under this arrangement, clients remit monthly payments based on the total number of active employees and pre-established single and family rates (e.g. $100/single and $250/family employee). Financial reconciliation of payments versus actual incurred claims is performed in accordance with an agreed-to cycle and surpluses and/or deficits are addressed at renewal with adjustments made to the current single and family rates.

• Monthly Billing

  A monthly billing statement is issued to clients who have elected to have some or all of their benefits managed under a fully insured financial model. Typical benefits covered under this model include travel coverage, life insurance, accidental death and dismemberment, and long term disability services. Under this arrangement, a deposit is collected prior to the effective date of coverage and the client is issued a monthly invoice with payment required in advance of coverage being in force. The billing statement includes insured monthly premium, plus administrative fees and applicable taxes.