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Claims Advocacy

Health Advocate
Medical Health Advisor’s highly personalized service provides assistance across a broad range of healthcare and insurance related issues, helping members deal with clinical, insurance and administrative issues involving medical, hospital, dental, pharmacy and other healthcare needs. The services are organized around Personal Health Advocates, typically registered nurses, supported by a team of medical directors and administrative experts, who assist individuals in getting the most value from their healthcare benefits.
 
One Call to Medical Health Advisor helps members:
  1. Navigate the healthcare and insurance systems
  2. Find doctors, hospitals and other providers
  3. Resolve insurance claims and billing issues
  4. Save time and money on healthcare bills
  5. Explain test, treatment and medications
  6. Health Cost Estimator – a pre-service pricing decision support tool
  7. Obtain unbiased health information to help members make an informed medical decision
  8. Schedule appointments with hard to reach specialists
  9. Identify renowned “best in class” medical institutions regarding a serious illness or injury
 
The Health Advocate Medical Bill Saver™ benefit can lower out-of- pocket costs on medical bills not covered by insurance. Advocates will work with healthcare providers and attempt to lower the balance on any uncovered medical or dental bill over $400.
 
Medical Bill Saver:
  1. Negotiation can result in 25-50% savings
  2. Easy-to-read, personal Savings Result Statement, summarizing outcome and payment terms
  3. Quick-Pay Fund available in applicable circumstances; you reimburse Health Advocate
  4. Provider sign-off on payment terms and conditions
PPB Claims Assist
Confidential Claims Advocacy
 
The economic environment has forced more businesses to move towards higher deductible health plans, increasing the complexity of maneuvering through the medical maze. This has made it more frustrating for employees.
 
As an added service to our clients, we developed PPB ClaimsAssist. Now employees can contact one of our claims advocates by using a convenient wallet card provided to them. They call or email us directly, without involving the employer, and get timely assistance on claims issues unresolved by the insurance company - saving everyone time and money.
 
Your PPB ClaimsAssist Advocate is ready to assist you by phone or via email

Eligibility Assistance

Many companies find that benefits administration can be a daunting and time consuming task. Submitting new hire paperwork as well as making sure employees are terminated on a timely basis is critical!
 
PPB EligibilityAssist is specifically designed to assist employers with the day to day administration of benefits eligibility.
 
A customized Universal Enrollment Form is provided with all benefits on one form, reducing the amount of paperwork required for a new hire to complete, thus saving them valuable time.
 
Simply send new enrollments, terminations and changes to your PPB Eligibility Specialist and they take care of notifying the insurance companies.

Compliance Assistance

COBRA Administration
COBRA administration is complex and may leave you at risk; failure to meet all COBRA regulations can result in substantial penalties and fines. Our COBRA administration service will simplify COBRA administration and ensure thorough compliance. From enrollment to bill payment, our administrative services keep you compliant and free from the burden of COBRA administration.
 
With over 12 years of benefit administration experience, we are uniquely positioned to simplify your experience. We offer a full-service COBRA solution with state-of-the-art technology to deliver unparalleled administration.
 
The MMA Administrators Advantage:
  1. Dedicated Client Service Representatives
  2. Fast posting through an automated lockbox
  3. Robust employee portals
  4. Dedication to plan compliance
  5. Integrated solutions
  6. Comprehensive reporting packages
  7. Core and Voluntary Billing Reports
  8. Responsive call center support
  9. Robust employer portals
ComplianceDashboard
Complying with the Federal laws that regulate health and welfare benefits has never been an easy task for employers. At a time when human resources departments are being asked to do more with less, the workload resulting from compliance continues to grow. In fact, healthcare reform may potentially add even more federal requirements and mandates to the list of employer responsibilities
 
Employers who take a casual or careless approach to compliance expose themselves to large fines and potential lawsuits. The American Recovery and Reinvestment Act funded additional auditing staff at the Department of Labor (DOL). As expected, this has increased the number of DOL audits of employers. Fines imposed by the DOL can be costly, reaching up to $1,100 a day, per plan for certain violations.
 
There Is a Solution
 
Employers need a tool to simplify the seemingly complex and intimidating world of compliance. One that automates this paperwork intensive process, is easy to use, and presents concise and relevant information.
 
Compliancedashboard is the solution that employers have been looking for. Through the innovative combination of web technology and legal research, it helps ensure employer compliance with health plan laws and mandates. This interactive web portal will tell you what you have to do and when you have to do it. Compliancedashboard breaks down an employer’s compliance responsibilities into clear and understandable topics, which are summarized on a Compliance Calendar. Employers receive email reminders to review these topics as appropriate. If a compliance topic is date sensitive, an employer will receive all of the information they need at the right time to complete the task.
 
Here’s a link to a brief video about Compliancedashboard Screencast
Employment & Benefit Law Attorneys
Access to a team of dedicated employment and benefit attorneys
Compliance Information
  1. Employment and Benefit Law alerts provided periodically
  2. Conduct periodic webinars and seminars on HR and benefits hot topics
  3. Mercer Know How – website providing HR related news, alerts, webcasts and a Compliance Calendar to help clients stay compliant with benefit and related regulations

Employee Communications

Overview
PPB works with you to develop a customized employee communication & education strategy using a variety of approaches including
  1. Group meetings
  2. One-on-one benefit counseling
  3. Employee Benefit Website
  4. Brainshark™
  5. Webinars
  6. Customized employee benefit guide
Employee Benefit Websites
As your broker, we can provide customized benefit websites to assist in bridging the gap in the employee communication process. Our totally customizable benefit websites allow you and your employees to access important and current benefit information and resources 24/7.
 
All of your plan information and any other documents and resources can be accessed through one easy to use web based portal, eliminating the need to navigate through a myriad of carrier sites and web pages to find the materials you and your employees need. Quickly and easily access your important plan and company information such as:
  1. Benefit Summaries
  2. Carrier Forms
  3. Online provider directories
  4. Plan booklets
  5. Employee handbooks
  6. New hire documents
These sites eliminate the need to keep blank carrier enrollment and claim forms in your files as they are quickly downloaded and printed from your computer.
 
The benefit sites are well organized and provide quick access to resources and other online services that will allow your employees to handle many benefit administration tasks by themselves. This allows more time to focus on more critical functions and aspects of your job.

HR Services

HR Coach
Many small and midsize companies find that coping with compliance issues can be a daunting task. Beyond just understanding the regulations, these companies need functional tools to assist them in staying compliant.
 
HR Coach is specifically designed for businesses that do not have their own full service HR department.
 
Red and Associates unique program provides owners and managers with their own HR Department…just a phone call away!
 
Red and Associates has professional HR coaches taking your calls and emails.
 
They are available to answer questions about things such as:
  1. Implementing a new policy
  2. Understanding a new regulation
  3. Performance issues
  4. Finding solutions to a current employee relations problem
  5. Setting up your own internal
HR systems 2. HR Coach is available from 8:00am to 5:00pm PST
MyWave Portal
Your HR portal is designed to offer you time-saving tools and resources that build convenience into managing your everyday work tasks. Whether you want to view documents online, participate in plan/program surveys or connect with more than 325,000 peers, this is the place to be. It’s easily accessible, hardworking and just one of the many services available to you when you partner with us.

PPB Consumerism Card

Overview
The number of employees covered under HSA and HRA accounts grew significantly in 2011 as employers struggle to keep their healthcare costs down. These plans have encouraged employees to become better consumers of their own healthcare, but there have been few resources available to help them do this.
 
We are excited to provide a solution by introducing the Prescott Pailet Benefits Consumerism Card to help your employees navigate the complex healthcare system. This Consumerism Card Program will give you the opportunity to strengthen the benefits you offer your employees by reducing their cost for healthcare services and making information readily available. Plus, it’s a great way to promote wellness, increase morale and reduce absenteeism – all things affecting your bottom line!
 
This program, which compliments any insurance plan, can be introduced with your current insurance program during open enrollment or can be offered on a stand-alone basis. Highlights include:
  1. Two packages starting at only $10.00 per employee per month
  2. Membership includes the employee and their immediate family members.
  3. Teladoc enables employees to consult with a doctor 24/7 and get a prescription with no office visit co-pay!
  4. Medical Health Advisor and Medical Bill Saver provide employees their own Personal Health Advocate.
  5. Employees save big on Dental Care, Vision Care, Lab work, Imaging, Prescriptions and more.
  6. Part-time, seasonal or retired employees can have benefits with a low per- employee, per-month cost.
Medical Health Advisor
  • One call helps members navigate the healthcare system, find the best doctors, resolve insurance claims, obtain health information and much more.
  • Highly personalized service by Medical Health Advocates.
Medical Bill Saver
  • Advocates work with healthcare providers on your behalf to lower out-of- pocket costs on medical or dental bills over $400 and support consumer- driven health plans.
  • Members receive an easy-to-read, personal savings results statement summarizing outcomes and payment terms.
Lab and Imaging Savings
  • Save 10% to 60% on lab testing nationwide through a convenient website ordering system.
  • Save 40% to 60% on CT Scans and MRIs.
  • Not available to NJ, NY and RI residents.
Teladoc
  • National network of board certified physicians providing cross coverage consultations via telephone or email, free of charge, 24 hours a day.
  • Consulting physicians discuss symptoms, recommend treatment options, diagnose many common conditions, prescribe and phone in medications to your local pharmacy when appropriate – FREE OF CHARGE.
  • Save time and money by avoiding unnecessary
  • Doctor’s office or ER visits – NO CONSULT FEE.
  • Reduces the cost to the health plan by eliminating the cost of an office visit.
  • Not available in Oklahoma.
Travel Assistance
  • Members have access to a worldwide network of medical and travel assistance personnel and emergency evacuation benefits when traveling over 100 miles away from home.
  • Not available to FL, OR, CT, and WA residents.
Pharmacy
  • Save 10% to 85% at over 60,000 participating locations, including independent, national and regional chain pharmacies nationwide.
  • The Mail Order Prescription Plan delivers your maintenance medications directly to your door with no shipping or dispensing fees. Ask about the $5 savings guarantee.
Dental Care
  • Save 15% to 50%* on everything from general dentistry and cleanings to root canals, crowns and orthodontia at over 92,500** dental providers.
  • Save on routine dental services such as x-rays and fillings. Plus, specialty care such as orthodontics and periodontics where available.
  • Not available to VT residents.
  • * Actual savings vary by service, provider and geographical area.
  • **According to Aetna’s Enterprise Provider Database as of 11/1/2010.
  • Not available to VT residents.
Hearing Aids
  • Save 15% at over 1,350 participating retail locations.
  • Save 40% to 60% off National Average Retail Pricing through a mail order program.
Vision Care
  • Save 20% to 60% on frames, lenses and specialty items at over 12,000 eye care professionals nationwide.
  • Save 10% to 30% on eye exams.
  • Save 40% to 50% off the overall national average on LASIK surger
  • Save 10% to 40% on most mail order replacement contact lenses.
Vitamins, Diabetic Supplies and Dermstore.com
  • Save 10% on already low prices – over 400 brands and 12,000 vitamin and nutritional products.
  • Diabetic Product packages are priced from $29.99/month to $169.99/month, which is 60% off the average competitors’ retail prices.
  • Save 15% on over 300 brands and 12,000 products at dermstore.com
Upgrades
You can upgrade your Consumerism Card benefits for an additional $5.00 per employee per month and receive these additional benefits:
 
1. LEGAL CARE DIRECT (UPGRADE)
  1. Plan attorneys will either charge $125.00 per hour, or 40% off their usual and customary hourly rate, whichever is greater. Network includes over 20,000 attorneys with an average of 19.4 years of experience. 
  2. No cost services include free simple will, free living will, one-on-one consultation on a new legal matter, phone call or letter written on the member’s behalf.
2. SAFE IDENTITY (UPGRADE)
  1. Early detection and warning: scans thousands of data sources and hundreds of records to find attempts to steal customers’ IDs.
  2. Unlimited service guarantee, free financial coaching for up to one hour with a certified credit or financial counselor, and free legal consultation up to one hour with an attorney.
  3. ID theft insurance, up to $25,000.
Disclosures: This plan is NOT insurance. The Plan provides discounts at certain health care providers for medical services. The Plan does not make payments directly to the providers of medical services. The Plan member is obligated to pay for all health care services but will receive a discount from those health care providers who have contracted with the discount plan organization. This discount card program contains a 30 day cancellation period. FL, LA, MD, MS, ND, OK, RI, SC, SD and TX residents: Member shall receive a full refund of membership fees, excluding registration fee, if membership is cancelled within the first 30 days after receipt of membership materials. AR and TN residents: A refund of all fees will be issued if membership is cancelled within the first 30 days. MA Residents: The plan is not insurance coverage and does not meet the minimum creditable coverage requirements under M.G.L. c. 111M and 956 CMR 5.00. The range of discounts for medical or ancillary services provided under the plan will vary depending on the type of provider and medical or ancillary service received. The discount medical card program makes available, before purchase and upon request, a list of program providers, including the name, city, state, and specialty of each program provider located in the cardholder’s service area. Discount Medical Plan Organization: New Benefits, Attn: Compliance Dept., PO Box 671309, Dallas, TX 75367. (800)800-7616. A list of providers is available at www.locateproviders.com. Teladoc does not replace the primary care physician. Teladoc does not guarantee a prescription will be written and operates subject to state regulations. Teladoc does not prescribe DEA controlled substances. Teladoc physicians reserve the right to deny care for potential misuse of services. Pharmacy discounts are not insurance and are not intended to replace insurance. The discount is only available at participating pharmacies. Program not available in WA, UT or KS.

Additional Services

  • Signature ready Form 5500 filings for health & welfare benefit plans
  • FSA and HRA administration
  • Online enrollment services
  • Customized wellness program
  • International benefits consulting
  • Single Source 1 – full outsourcing of benefits, HR and payroll
  • Industry leading benchmarking data
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