Services

AIR provides a wide range of consulting services for group health programs, the placement of stop loss insurance, prescription benefit programs, vision, dental, short term and long term disability programs as well as other group benefits that your firm may benefit from our 200+ years of experience.

We also have assisted customers in the development of on-site and off-site clinics, Health Risk Assessment Programs and disease management programs for their group health plan participants.

Alternative Insurance Resources, Inc. provides a comprehensive administrative services package to each of its clients.  It is our objective to provide our services in such a way that minimizes administrative burden of plan management for our clients.

Group Medical and Dental Plans:

• Initial enrollment and communication
• Development of Plan document and Summary Plan Description
• Aggressive negotiation of stop loss terms
• Electronic enrollment
• PPO Management
• Claims Adjudication
• Toll-free customer service
• Electronic Claims
• Periodic plan reporting and analysis
• COBRA Administration
• Internet member access to claims information
• Coordinated FSA Administration
• In house precertification, case management and utilization review
• Pharmacy Benefit Management
• Subrogation
• Bill Negotiation

Plan Reporting:

Our periodic management reports are designed to be more useful to management in making critical decisions regarding plan performance, plan design, and financial planning.

We customize reporting packages to meet the unique needs of our clients.

Claims System:

Our claims management system is fully integrated with our FSA, HRA, COBRA, Dental, and workers compensation systems.

Insurance Products:

• Stop Loss (Reinsurance) with or without AIR as an administrator
• Group Life and AD&D Insurance
• Long and short-term disability

Workers Compensation:

• Claims payment
• Arrange survellience
• Arrange loss control services
• Arrange legal services

HRA & FSA Processing:

• Small and large groups
• With or without FlexCard access to benefits
• Plan design and communication

Customized drug card programs:

• Copayment based programs
• Deductible & coinsurance plans
• Discount only arrangements
• With or without AIR as administrator

COBRA Administration:

AIR offers professional COBRA administrative services to clients with or without AIR as TPA for the core benefit plan:

• Cost effective – AIR’s pricing policy is designed to create an affordable alternative to an otherwise burdensome process;
• Convenient – We handle the majority of the work; from mailing notices to tracking eligibility dates, to billing and collection of premiums;
• Regulatory Compliance – Many steps are required for proper COBRA compliance;
• Record Keeping – Payments are collected and posted to participant’s history and reviewed monthly.  Any necessary letters or notifications are posted to history;
• Communication – COBRA participants are often former employees that are not always happy.  We handle all of the communication necessary and keep you informed;
• Experience – We process more qualifying events in one month than some companies will process in years.

Outsourced Health Plan Components:

PPO Networks – We are not affiliated with any single organization.  This gives us the flexibility to work with any organization that best meets the needs of our clients.

Utilization Management – AIR utilizes the professional services of Phoenix Care Management, with staffing in our offices, for utilization management, precertification, and disease management services.  Services include catastrophic case management, discharge planning, concurrent review and retrospective reviews.

CareHere! – Designed for groups with as few as 100 employees in a single geographical location, Carehere provides “on-site” medical clinics for its clients.  With a physician on site, Carehere is able to produce significant cost savings to the employer while improving healthcare and, more importantly, the wellness of the employees or the organization.

Pharmacy Benefits: AIR offers relationships through PartnersRx and Pharmacare.  Both networks offer the optimum level of access and cost control necessary in today’s market.

Alternative Insurance Resources, Inc. has experience in the design and management of self-funded medical and dental plans.  While self-funding is not for everyone, self-funding through AIR can be profitable to employer groups as small as 50 employees.

We put all of the components in place:

• Design of benefits
• PPO Network(s)
• Stop Loss Coverage (Reinsurance)
• Managed Care Components
• Pharmacy Benefit Program
• Wellness Initiatives
• Employee Communication

Advantages of a Partially Self-Insured Program:

Plan Design:
Under a self-funded plan, a client can design their program to fit the unique needs of its organization within certain limitations.

When plan changes are appropriate, the client can make targeted changes to meet a particular need without having to totally change plans, as is the case in most fully insured plans.

The AIR Advantage:
Using AIR as administrator, the group is not limited to a short list of standard “off the shelf” plan designs common to most larger TPAs and insurance carriers.

We are very flexible in the design of your plan giving you more control over the benefits (and their costs) that best fit your unique organizational needs.

Lower Costs – Improved Cash Flow:
Under a fully insured plan, premiums are payable in advance, premium costs include hidden administrative costs, premium taxes, commissions, and underwriting profits.

In years where claims experience is favorable, the carrier keeps the profit.

From a cash-flow perspective, premiums are payable in advance each month.  In a typical plan, the employer has paid claims costs well in advance of the time it takes for the insurance carrier to receive, process, and pay the claim.

The AIR Advantage:
With a self-funded plan administered through AIR, administrativecosts are lower and specifically identified.  Premium taxes are significantly lower (and included in stop loss premiums) and, most importantly – Underwriting profits accrue to the benefit of the employer – not the insurance company.

From a cash flow perspective, only the fixed costs (administrative and stop loss premiums) are paid in advance.  Claims costs are only paid after the TPA has received and processed the claim.

Renewal Considerations:
In a fully insured plan, there are few options for renewal at the end of the year.  If plan experience is not favorable, your carrier will probably increase rates – regardless of the reason for the experience.  Then . . . .

If renewal terms are not favorable you may:

• Move to a lower cost “off-the-shelf” plan offered by the same carrier; or
• Change insurance Carriers – with new plan design, new ID cards, new phone numbers and possibly a new PPO provider list, etc.
• Fully insured carriers typically underwrite retrospectively – to recover their losses

The AIR Advantage:
One of the biggest advantages of self-funding through AIR is what happens at the end of the policy year..  In the event of a favorable plan experience:

• A detailed evaluation of plan experience may reveal a condition or a claim that is non-recurring – leaving no reason for any changes;
• If plan design changes are needed, we can make design adjustments targeted at the cause of the negative experience without turning the entire plan upside down;
• If stop loss terms are not favorable, AIR uses a number of carriers where rate terms can be compared and competition will yield the best possible results.  In the event we recommend a changein the stop loss carrier – the move is transparent to plan participants (same ID card, same administrator, etc)

Plan Design Considerations:
Whether you favor a copayment based plan, the old “Deductible then 80/20” plan, or one of the newer Consumer Driven Health Plan alternatives, one of the advantages of self-funding through AIR is the almost limitless number of plan design options that we can design and administer on your behalf.

Copayment based plans – Physician’s office visits with a copayment (we can distinguish between primary care and specialists if needed).  Copayments for pharmacy – generic, preferred brand, and non-preferred prescriptions;

Coinsurance based plans – For employees who have lost touch with the “real cost of healthcare”, consider a plan that pays 67% for all benefits with a $2,000 out-of-pocket maximum with or without a calendar year deductible.

Triple Option Plans – We can build a plan that favors a particular hospital or physician’s group, with a second tier of benefits for PPO providers, and a third tier of benefits for non-participating providers;

Wellness Initiatives / Physician or Nurse on Site: For employers with more than 250 employees in one geographical location, we can design a plan that provides motivation for participation in wellnedd initiatives designed to drive down chronic health-care costs.

This is YOUR plan.  We encourage our clients to be active in the development of a plan design that best meets the unique needs of the organization.

An important element to any partially self-funded plan is the stop-loss insurance that protects the plan in the event of significant or catastrophic claims.  AIR works with a number of carriers who offer this coverage and we are very experienced in designing and marketing the stop loss coverage that is best for your organization.

Our Markets: All markets are not the same and, while rates are important, there are other factors to be considered in choosing a carrier for your plan:

Financial Strength: All or our carriers are “A” rated or better and have the financial capacity to pay a claim when it is necessary.

Quality Service: Just because a carrier has a strong financial rating does not necessarily mean that they provide fast turnaround on claims and other administrative issues.

Flexibility: We look for carriers who have the capacity to accommodate special needs and circumstances, as well as unique plan designs.

Competition: There are many administrators that have all of their business concentrated with one or two carriers.  We think that’s great for the carrier- but bad for the clients.

The AIR philosophy is built around making our carriers compete for your business.  For this purpose, we market our plans to a number of carriers to obtain the best terms possible for our clients.

Specific Stop Loss Coverage
The first level of protection for any self-funded plan is known as “Specific” or “Individual Stop Loss” coverage.  This coverage is designed to protect the plan from significant losses by any individual during the plan year that might result from an accumulation of claims or from a single catastrophic event.
We recommend Specific deductible levels to our clients based on specific criteria, such as the size or the group, expected claims, and prior experience with self-funding.

The employer is responsible for payment of claims each year up to the amount of the Specific deductible.  Claims in excess of that total are reimbursed by the stop loss carrier.

Aggregate Stop Loss Coverage

Aggregate stop loss coverage is designed to protect the group in the event of an accumulation of claims that are not reimbursable; under the specific stop loss.
Not all groups choose to purchase Aggregate Stop Loss.  However, we normally recommend coverage to groups in their first year of self-funding and for smaller employers.

AIR – Self Funding Advantage
Alternate Insurance Resources, Inc. has the expertise, the experience, the flexibility, the knowledge, and the system to build the self-funded health and/or dental plan that meet the needs of your organization.