Significa Benefit Services takes a comprehensive approach to self-funded plan administration. Throughout the years, the employee benefit needs of our clients have changed as their businesses have grown and prospered. Significa Benefit Services responded by developing a variety of innovative products and services. This flexibility workforce enables Significa Benefit Services to tailor a health plan to the unique needs of a client's workplace. We have core competencies in the following areas:

Significa Benefit Services experienced benefits specialists will develop a customized plan design based on the specific goals and objectives you identify. Customized plan designs are achieved by focusing on:

  • Cost-sharing (copayments, deductibles and coinsurance)
  • Health management and wellness
  • Other cost-control features (exclusions, subrogation, coordination of benefits, etc.) intended to curb utilization through various incentives and disincentives
  • Risk tolerance
  • Stop-loss coverage to protect the plan against catastrophic and aggregate risk
  • Robust reporting to monitor plan expenditures and evaluate benefit utilization and trends
  • Regulatory compliance assistance
  • Provider negotiation services

The Consolidated Omnibus Budget Reconciliation Act (COBRA) generally requires that group health plans sponsored by employers with 20 or more employees in the prior year offer employees and their families the opportunity for a temporary extension of coverage in certain instances where coverage under the plan would otherwise end.

If requested, Significa Benefit Services will provide the following services to assist with your plan’s COBRA obligations:

  • Provide general notices to subsequent enrollees
  • Provide election forms to qualified beneficiaries
  • Collect and remit payment to you
  • Track COBRA eligibility periods, terminations and cancellations
  • Review second qualifying event and disability extension requests
  • Provide general notice and election form reporting

Contact Significa Benefit Services for more information regarding these services.

Significa Benefit Services has established a strong relationship with many "A" rated stop-loss carriers. Available coverages include individual specific, aggregate and aggregating specifics and level funding.

Stop-loss administration services include premium invoicing, notice of potential shock claims, 50 percent of specific paid claims report, specific claim reimbursement request and monthly aggregate reporting.

Because we have relationships with many reinsurance carriers and managing general underwriters, Significa Benefit Services is able to obtain a number of competitive quotes for our clients. Each year we shop our clients' stop-loss coverage to ensure that they are in the most competitive and financially sound program available.

Self-funded plans sponsored by private sector employers are subject to the Employee Retirement Income Security Act (ERISA). ERISA requires that plans be committed to writing. In addition, ERISA requires that plan participants and beneficiaries be provided with a written summary of the plan's provisions and stipulates the exact information that must be included in the summary plan description.

Self-funded plans and/or their private or public sector sponsors are subject to all other federal statutes and regulations. Based on plan type (medical, dental, vision, etc.), plan sponsor type (private or public sector) and number of employees, compliance with any or all of the following may be required:

  • Affordable Care Act (ACA)
  • Health Insurance Portability and Accountability Act (HIPAA)
  • Consolidated Omnibus Budget Reconciliation Act (COBRA)
  • Family and Medical Leave Act (FMLA)
  • Uniformed Services Employment and Reemployment Rights Act (USERRA)
  • Women’s Health and Cancer Rights Act (WHCRA)
  • Mental Health Parity and Addiction Equity Act (MHPAEA)
  • Newborn’s Act
  • Americans with Disabilities Act (ADA)
  • Pregnancy Discrimination Act (PDA)
  • Age Discrimination in Employment Act (ADEA)
  • Various sections of the Internal Revenue Code
  • Various budget reconciliation acts
  • Genetic Information Nondiscrimination Act (GINA)

Many third party administrators use vendor-supplied, automated document processing software. Significa Benefit Services does not. The customized plan designs developed by our benefits specialists are best served by customized documents. The documents that Significa Benefit Services provides are custom-crafted, periodically reviewed for ongoing compliance and amended, when necessary, by a dedicated, in-house compliance specialist.

With prescription and specialty drug costs on the rise, our clients require that we have competitive, comprehensive and cutting edge pharmacy benefit management solutions available to them. To that end, Significa Benefit Services clients have a choice of five nationally recognized Prescription Drug Card vendors for retail and mail order prescription services. In addition to the network pharmacy and mail order pharmacy services, these partners provide integrated Prescription Benefit Management services, including benefit consultation, drug utilization review, formulary management, disease management and medical and drug data analysis services.

With 80 percent or more of healthcare costs going towards claims, negotiated discounts through PPO networks are a critical component to risk management. Significa Benefit Services has access to a large number of local, regional and national PPO networks which offer broad access and competitive discount arrangements. Click here to see the networks which we currently offer to our clients.

As evidenced by federal and state health care reform initiatives, staying up-to-date with the numerous statutes and regulations affecting employee benefit plans is challenging. According to Fred Hunt, President of the Society of Professional Benefits Administrators (SPBA), government compliance “is the single biggest risk factor that plans face.”

At Significa Benefit Services, compliance is given the respect it deserves. We maintain memberships with the two preeminent professional employee benefit organizations - SPBA and SIIA. They provide frequent communications about employee benefit laws and their interpretations. We also attend SPBA and SIIA meetings to discuss compliance concerns with government regulators.

Every aspect of your plan will be administered with a focus on compliance. At implementation, your plan design will be subject to a compliance review before the plan document is finalized. We routinely track the 1,500 or so new laws, regulations, official opinions, directives and major court decisions that take place in any given year. Subsequent to implementation, we will provide ongoing email communications focusing on breaking news about regulatory issues. These emails are a time-saving resource for keeping you informed about your plan's compliance obligations.

Reference based pricing (RBP) is a new twist on the defined contribution concept in employment based health benefits, recognizing substantial savings over traditional network arrangements.

Plan sponsors choose to pay a fixed amount of healthcare services, (i.e., 150 percent of Medicare reimbursement fees) and the health plan member pays the difference, if the provider charges more than the allowed amount.

RBP can save employers money, however, communication to members is critical to developing a comprehensive, transparent, RBP program.

Please contact Significa Benefit Services if you are interested in designing an RBP benefit plan.

Utilization Management services are based on the simple philosophy that quality medical care will be cost effective when properly managed. Significa Benefit Services offers managed healthcare programs through quality independent vendors. A broad range of services including precertification, utilization and concurrent review, discharge planning, large case management, bill review and audits and out-of-network fee negotiation can be provided. In addition to these traditional medical management services, our vendors offer extensive proactive clinical intervention programs.