The Benefit Group believes that providing excellent service to our clients requires much more than simply paying claims. We firmly believe in building relationships. This allows us to identify the client’s individual needs so we can help control costs and provide a comprehensive employee benefit package.
Not only can TBG tailor your benefit package, we can customize your administrative package as well! You have the ability to decide whether you would like TBG to administer the complete benefit package, or just a few select services.
Services offered in the administrative package include:
Access to Many ‘A’ Rated Reinsurance Markets
We believe in working with competitive, reputable reinsurance markets. This is why we review financial backing and contracts carefully before working with any new carriers. We believe it is our job to take care of potential problems before they happen. We currently work with many A.M. Best rated ‘A’ or better reinsurance carriers. What is the Carrier’s AM Best Rating? A.M. Best is the oldest and most commonly used rating agency. These ratings represent an independent opinion of the carrier’s financial strength and ability to pay claims. The top ratings are A++ and A+. Both ratings are given the distinction of being superior. It is recommended that you only use a carrier that is “A” or “B” rated or higher.
Wide Variety of PPO Networks
We believe that managed care is an effective cost containment feature for any benefit plan. We have access to many local and national networks allowing us to provide networks almost anywhere in the continental United States.
Plan Document Preparation
Our in-house legal staff will prepare your plan document and assist you in making decisions with regard to plan design and legal issues.
Enrollment & Eligibility Online
With recent changes in Federal Law, determination of an individual’s eligibility is growing more complicated. TBG’s enrollment and eligibility department can assist with the enrollment process and eligibility questions.
Each group will have an assigned claim representative. This person has a backup team of four persons in the event that your representative should be unavailable. We provide claims administration services for medical, dental, vision, prescription drug cards, weekly income, long-term disability and life.
COBRA Administration Online
TBG offers complete COBRA administration services as an option for our clients.
HIPAA Administration Online
If you choose, TBG can issue Creditable Coverage Certificates as mandated by the Health Insurance Portability & Accountability Act of 1998.
Prescription Drug Cards
We have online eligibility access with our preferred drug card vendors, providing our clients with instant prescription services.
Comprehensive Reporting Package
Reporting is an additional service we offer that can be tailored to suit your wants and needs.
Customer Response Team
Our philosophy to providing good service is being proactive. Your Customer Response Representative will make regular service calls to ensure that TBG is providing the quality service we take pride in.
Dedicated Provider Relations Line
Providers call in on a dedicated provider line to keep our toll-free lines open for your calls.
Comprehensive Renewal Process
With the constant changes in the market and within the insurance industry, we believe in marketing your package each year. This allows you to see where the market is and to compare it with your renewal offer, ensuring that you will have a fair and competitive renewal.
Our utilization management program provides medical necessity reviews that ensure members receive the appropriate care they need while maximizing opportunities for cost savings.
Our case management program is designed to improve the quality of patient care while maximizing cost savings. It works in collaboration with our utilization management product which triggers cases that may benefit for case management.
Claims Editing and Out of Network Negotiation
Solutions that are 100% automated are unlikely to produce reliable results. Our team is assembled of talented and experienced review and negotiation professionals who find connections where data may not, formulate pertinent questions, and interpret the results.
Medical Bill Review
Most employers would not only be surprised, but shocked to know that the majority of their high dollar claims are simply paid by applying a PPO discount. Our proprietary software provides board certified physicians the ability to efficiently audit and confirm the accuracy of hospital and facility bills.
Reference Based Reimbursement
Our unique RBR solution provides plan reimbursement methodology based on fair market value of the services rendered allowing optimization of every health care dollar.
We use direct contracting and narrow networks to reduce any potential member disruption. If the employer has a significant number of employee health plan members in a competitive market this is a great opportunity to have providers compete for employer business.