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P a g e
Your
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the plan, and fund reserves, among other factors. A full “Funding Projection” report will be
provided and reviewed.
A loss ratio comparison by plan is performed on a
monthly
basis, and is included in our
Monthly Claims Summary. A loss ratio by tier can be shown regularly if a client wishes;
however, these ratios can be very easily skewed due to a single claim or time frame. The
consistent validity of loss ratios by tier is questionable.
What is your philosophy on the reserve needed by a health plan?
CBIZ actuaries utilize a proprietary IBNR analysis to determine an accurate reserve for its
self- funded clients. A detailed Reserve Summary is provided to the client for internal and
auditing reasons. This report utilizes lag reports from the carriers, along with trend for both
medical and Rx claims. With over 75% of claims now being auto-adjudicated, claims are
processed extremely fast these days. Therefore, reserves can be set much lower than in the
past, sometimes as low as one times expected monthly cost.
How often do your recommend analyzing and adjusting plan premiums and tiers for plan
costs and expenses?
Premiums and tiers for plan costs and expenses should be
analyzed
on a consistent basis, at
least discussed in detail quarterly. However
, adjusting
them is usually done on an annual
basis at renewal.
How often do you recommend vendor claims audits?
Most carriers have internal independent audit procedures in place, so auditing by an outside
firm is a waste of client money. However, if there is no procedure in place, once over 5 to 10
years is recommended. CBIZ has an internal practice that can perform claim audits, along
with dependent audits.
What role would you play in the determination and payment of Transitional Reinsurance fees
and Patient-Centered Outcomes Research fees?
Unfortunately, CBIZ cannot directly pay Transitional and PCORI fees to the government for
our self-funded clients. However, we do provide the analysis of the most cost effective
method of determining membership for our clients. We have found our analysis is saving our
larger clients tens of thousands of dollars using the “factor” method.
Should the District decide to add a benefit that does not exist currently, such as an employee
health clinic, please describe the cost structure of additional benefit proposals/marketing?
There is no other consulting firm in the business with more knowledge and expertise than
CBIZ when it comes to health and wellness clinics. We have a division in our Kansas City
office dedicated to this specialty, and have implemented more clinics for school districts than
anyone. The cost to enlist their assistance is not included in this proposal, and can vary
greatly from case to case based on scope of services. However, CBIZ discounts the cost
considerably if CBIZ is also your benefits consultant.
The basic steps in the implementation process of a wellness clinic are as follows:
1. Feasibility Study to determine possible savings, structure, hours, services and other
details regarding the clinic. A health and wellness clinic is a huge investment for a
District, so a comprehensive Feasibility Study is highly recommended! .
2. Request for Proposal and Vendor Selection – CBIZ has relationships with all the major
national and local vendors in this space, and will contact the appropriate companies
based on scope and objectives.