The Segal Group is uniquely qualified to help health and welfare plan sponsors find the right solutions to the issues arising from today's challenging healthcare environment. We have pioneered many innovations in health benefit design, purchasing, cost management and communications. Our focus has always been on carefully crafted strategies that make business, philosophical and practical sense to trustees. Visit the links below to learn how our broad suite of services, technical prowess and focus on unbiased advice that is customized to each client make us right for you.
Effective plan design is the key to providing high quality, cost-effective health care to multi-employer benefit plan members as well as public sector and private sector employees. Segal has extensive experience in the design and redesign of all health benefit plans, including medical, dental, prescription drug, vision, short- and long-term disability, life, accidental death and dismemberment and flexible benefits.
Segal has developed multiple strategies for designing plan rules such as rules of eligibility and waiting period, coordination of benefits, and participant cost sharing. We model the cost impact before a plan is changed (e.g. from a 100% reimbursement to 20% coinsurance), so we can predict with accuracy how much the change will save a fund or plan.
We use a number of strategies to enhance the health plans of our multi-employer, public sector and private sector clients. These include:
Proper budgeting and financial monitoring is key to sustaining a health and welfare plan.
Segal is able to help trustees with the following services:
In addition to establishing a cushion to fall back on during unfavorable financial periods, there are many good reasons to set aside reserves, including:
Segal can assist in reviewing the fund's reserve policy or developing a policy if one is desired. We can also evaluate the fund's current target reserve levels and evaluate whether the fund is at risk for insolvency.
Our consultants are able to help plan sponsors with the following services:
Since 1973, Segal has conducted scores of retrospective on-site claims audits of health plans.
As prior claims examiners, our auditors have extensive background in claims processing and auditing. This experience makes them uniquely qualified to evaluate established administrative procedures, suggest areas for improvement and ensure proper controls are in place for efficient plan administration.
Each audit project is tailored to the plan's specific concerns and objectives. We offer a multitude of services relating to claims adjudication of all plan expenses (i.e., medical, dental, disability, vision, life insurance). They include:
Estimates suggest that eligibility errors are prevalent in health plans. In fact, eligibility audits are reported to produce 10 - 15% reductions in the number of eligible dependents. To protect against financial losses, it is imperative for group health plans to use eligibility safeguards and perform audits.
Segal can conduct eligibility audits to identify:
You should consider an audit if your plan:
Strategies and recommendations for eligibility audits vary based on group size and benefit philosophy. Segal can help plan sponsors establish appropriate controls to ensure that benefits are only paid for eligible employees and dependents.
Plan data analysis can give multi-employer plan trustees and sponsors of public sector and private sector health plans a valuable insight into plan costs and usage to improve decision making and financial analysis. Plan data analysis can determine the root causes of cost increases, which allows for targeted and effective intervention to manage future health care expenses.
Segal's plan data analysis services include:
One way plan sponsors can contain costs and better serve plan participants is by encouraging participants to take care of their own health. Through behavioral programs that reduce the prevalence and severity of illness in a population, members can enjoy a better quality of life, and the plan's claims costs will decline.
Segal can conduct an inventory of a plan's current wellness benefits and initiatives and develop a wellness action plan that can help trustees establish effective health management programs that support members and their dependents. These programs include:
Segal offers a range of compliance services and publications to help multi-employer fund trustees and sponsors of public sector and private sector plans ensure they are in compliance with any policies and/or related contracts.
Rapidly rising prescription drug costs are driving overall increases in the cost of health coverage. Segal can help multi-employer funds as well as public sector and private sector plans manage the cost of prescription drug coverage through a variety of services, including:
Segal works to get the most from vendors for all the clients we represent. We make it our business to know a vendor's history, financial solvency and performance-to-date, and we bring that knowledge to the table on behalf of our clients.
Our renewal and competitive bidding services include:
Choosing between self-funding or insurance will impact a plan sponsor's finances, reserves and contribution requirements.
Some plans with significant levels of cash reserves can reduce costs by self-funding their health plans or assuming more risk. However, before doing this, a plan must carefully consider the ramifications and protect itself against ordinary or catastrophic risks.
Segal can help trustees and other plan sponsors determine if self-insuring or other cost-saving funding arrangements are right for their fund or plan. We can also help funds that are already self-insured evaluate whether self-insuring is still the best choice.
Self-insured funds and plans can protect themselves against large claims or fluctuations in claims by purchasing stop-loss insurance, which sets a limit on how much the fund or plan will have to pay for individual or aggregate claims. Segal can help trustees and plan sponsors with:
Providing health benefits for retirees presents health plan sponsors with many challenges. Segal can help find solutions that work for both the plan sponsor – whether it is a multi-employer fund, a public sector entity or a private sector organization – and the retirees.
Services we provide include:
Our consulting team includes experienced actuaries, insurance experts, claims auditors and client managers who are dedicated to helping plan sponsors address their unique health and welfare benefits challenges.
Our consultants approach health and welfare benefits from three overlapping perspectives:
The area of focus varies depending on the needs of the plan sponsor, and it can always be analyzed using the underlying data.