As a house needs a basement as a solid foundation, so too does a company require a stable and effective plan design in order to have a secure benefit plan for the long term.

Some employers are only focused on the cost factor at the on-set and they miss out on the long term savings of a well-designed benefit package. A plan designed to specifically meet the existing and evolving work force means not paying for items not valued by the employees and focusing on removing unnecessary exclusions and limitations.

Areas of plan design overlooked include LCA (least cost alternative) for drug claims, which should not be confused with a generic equivalent drug definition. Least Cost means just that—the least costing drug within that drug family. What about the requirement for a prescription for paramedical professional services such as massage, chiropractic, etc? This makes making claims more cumbersome to an employee who has to make an appointment with their general practitioner doctor, wait to get into see that doctor for a simple referral in order to make the claim. What happens if the employee has gone for the services first because they ‘didn’t know’? Claims are rejected in full and the employee walks away unhappy and spreads the unhappy news with co-workers thereby eroding the fundamental purpose of an employee benefit plan developed for the satisfaction of employees.

Another bone of contention for people making claims is the dental fee guide and the employee attends a dentist who is non-compliant with the averages applied for dental claims and the employee is then out-of-pocket, with after-tax dollars for these extra charges.

Implementing an ‘I thought’ benefit is common as well; group critical conditions verse group critical illness insurance. Having an ‘any occupation’ disability definition as compared to an ‘own occupation’ is as different as night and day when it comes to making a claim.

Allow us the opportunity to review your benefit plan design and ensure the coverage is what you not only want it to be, but what it needs to be when you need it to be there for you and your employee members.

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