Customizing Plans for Public and Labor Clients

Customizing Plans for Public and Labor Clients
August 25, 2022 Sue Riordan

Managing health care and keeping costs down is a challenge for all organizations.  However, our experience with labor plan administration has taught us labor fund administrators have very specific needs. These come not just in managing the plan, but also in managing expectations.

As a labor fund administrator, you face issues with maintaining fund control, overseeing plan administration and communicating with members. And the most important goal, of course, is to keep your members and their families healthy.

Meritain Health® and its flexible platform is perfect for labor funds and can be tailored to address your biggest needs.

Additionally, we track current trends across public and labor business. From this information, we’ve developed processes that have been very successful with labor funds.

Here are some options that may be just right for your fund and your membership:

Flexible claim processing with “pause and pay”

To help make reviewing claims easier, labor funds can review claims prior to making payments to providers. This preapproval process, nicknamed “pause and pay”, lets funds see a list of all claims in ready to pay status every week. If any need further review, funds can simply “pause” on those claims and a supplemental report can be provided.

The feature can be especially helpful if funds have an active fund office or are transitioning out of a shared service model.

Multi-level portal access

Funds benefit from having access to multiple administrative tools and reporting capabilities through a secure web portal. To ensure success, these tools should be set up and customized with varying levels of permissions.

Then, administrators can view information they need when handling incoming member calls. Fund managers also gain from being able to perform quick tasks, like submitting forms or requesting member ID cards.

Community tools

Creating a virtual community allows a benefits administrator and groups collaborate to resolve member questions and issues quickly and efficiently. Advanced customer service platforms also allow for complete transparency.

Detailed analytics

For viewing data, fund administrators need access to standard monthly reports, as well as custom reporting capabilities. Transparency into spending, plus the ability to quickly analyze trends, utilization and health risks is key.

Standard reports typically include:

    • Monthly management reports.
    • Transaction reports.
    • Plan performance reports.
    • Aggregate reports.
    • Check registers.
    • Flex account balances (if applicable).
    • Incomplete claims reports.
    • Refund, specific and void reports.
Custom stop loss administration and reporting

Stop loss is critical to managing overall spend. Likewise, custom stop loss reporting to help labor funds maximize their stop loss coverage is an important factor in managing this cost. We’ve developed stop loss reporting specifically for labor clients.  Additionally, Meritain Health has established strong relationships with stop loss vendors, such as Ullico, to help tailor design solutions geared toward labor unions.

Case management solutions

Staying on top of ongoing medical cases can be a challenge for fund administrators. Members often call their fund administrator with questions and concerns with ongoing case management. Because of this, funds should be able to access an easy-to-use system to review progress and view notes on member cases. This opens up two-way communication, and drives improved clinical outcomes and support.

Plan design flexibility and grandfathered status

Looking at historical data helps in reviewing past utilization and planning strategies for the future. A plan administration partner needs to offer deep flexibility and the ability to accommodate most plan design features.  Grandfathered status should also be taken into account. Creative and flexible plan design solutions should be available, while maintaining valued benefit designs and keeping costs low.

Member communications

To make it easy for funds to relay helpful information to members, custom communications should always be an option. Messages can be added to regular communications.  These may include contact information, phone numbers, etc. and can be added to an Explanation of Benefits (EOB) or other frequent communication.

Optimizing point solutions and vendor integration

Point solutions complement existing products and are essential for connecting members to added benefits. Platforms should offer seamless integration with outside vendors, so incorporating administrator-arranged or fund-administrator-preferred point solutions is easy.

Also, point solutions should try to address a plan’s most pressing risks as well as emerging health trends. Currently, big themes we see in the market are virtual primary care, musculoskeletal care, price transparency and digital solutions for access and mental health support. Finding a partner who excels in point solution optimization is critical for better member engagement and benefit success.

Choosing Meritain Health 

Meritain Health has expert solutions for each of the opportunities outlined in this article. We offer deep flexibility and customization for all our plan sponsors. And we have proven strategies for labor partners. Contact us to learn more about how we can support you.