EMPLOYEE BENEFITS – THE IMPORTANCE OF THE PLAN ADMINISTRATOR
Our corporate customers understand that good benefit plans are key for employee retention. Many executive hours are spent obtaining, evaluating and selecting the best Life and Health insurance plans for the organisation. But the true value of any employee benefit plan cannot be realized without an experienced Plan Administrator who understands the vagaries of the policies and can properly onboard new employees while keeping abreast of the changing circumstances and claims of all staff members.
We urge all our EBS clients to call upon our Account Executives whenever there is a change in a plan administrator so that we can properly review and explain the key components of your policies. Here are some of the critical factors that plan administrators should monitor to ensure employee satisfaction with their life and health policies:
Period of Grace. A new employee (and family) is given 30 days after confirmation to be registered as a member of the life and health plans without requiring a medical examination. Once that period expires, the insurer can request a medical examination and can restrict or even deny coverage for pre-existing conditions. Obtaining the completed forms as soon as possible after confirmation should be a priority.
New Family Members. Likewise, when sending out the congratulatory message to the new parents, an automatic reminder to add the newborn to the group health policy should be made. The new bundle of joy translates into sleep deprived, forgetful employees, so automated reminders via email or whatsapp may be necessary.
Customised Policies. Most group policies are customized for the policyholder and group policies are seldom exactly alike. It is therefore important to review policy limits and conditions with new employees so that they understand the requirements, the maximum limits, deductibles and filing requirements. Some insurers apply more deductibles than others, so employees may receive a lower percentage of the claim than they were accustomed to under a previous plan, or vice versa.
Complete and Signed Claim Forms. All insurers health claim forms bearing the ATTIC logo can be used for medical claims (with the exception of specific executive medical plans), so it is not necessary to get a specific insurer’s claim form completed by the medical professional. It is important that the medical professional complete, sign, date and stamp the form and that the form is also completed and signed by the employee.
Original Bills. Insurers require original bills for reimbursement. They coordinate with other insurers when there are two or more insurance policies. The plan administrator needs to be clear about which health insurance policy takes precedence.
Review Payments. Most insurers have now implemented ACH payments and the broker is not always informed when a claim is made. Employees should review their claim payments as soon as they are received and immediately seek clarification when the payment is lower than expected (after applying the appropriate deductible and checking the sub-limits).