Second Day Services
1: 24/7 Services
When you become a PBM client, you will have a dedicated employee benefit account manager who is familiar with your plan and available to you 24/7 to assist with eligibility, claims and billing questions in English and Spanish. Our immediate response to your service requests empowers you to address your employees’ questions when they arise so they don’t have to delay visiting their doctor or filling their prescriptions.
Your account manager also helps you and your employees transition between insurance carriers. During the transition, there may be a brief period when employees haven’t been loaded into the new carrier’s eligibility system. If this occurs, PBM will pay for medical services and prescriptions that your employees obtain during this lag time. They would otherwise have to pay out-of-pocket.
2: Communication
Clarity is the main ingredient of effective communication. It’s especially important when the topic is as intricate and important as choosing a health care plan, understanding a health savings account or promoting a wellness program. When employees understand their benefits, they’re more likely to be engaged, their morale improves, they make better health care decisions and they tend to be healthier and more productive.
Employee benefits packages are the most powerful recruitment and retention tool Employers have. And for that reason, an effective, focused communications program is imperative.
At PBM, we help Employers communicate and employees understand. Our communication advisors develop customized employee communications for our clients. We use a variety of print and online tools to target the message for your group and continually monitor them for results.
Our team of benefits experts, writers and artists offer a full-service approach – from concept to completion. We jump right in to develop effective, visual communications that are unique to your needs and objectives.
3: Employee Resouce Center
Our trained benefits administrators can answer your employees’ phone calls, giving them a vehicle for benefits support without draining your human resource staff. PBM response center can be engaged for high-volume short assignments, like open enrollment, and for extended projects, like claims consultation throughout the plan year. Because our call center is managed in-house, the professionals taking your employees’ inquiries can speak knowledgeably about your benefit plan and give answers promptly.
If you have non-English speaking employees, our call center is staffed with English/Spanish bilingual personnel and can manage interpretations for more than 140 other languages.
4: Corporate Wellness
Just as an athletic trainer wouldn’t prescribe the same training schedule for a marathon runner as for a casual walker, we don’t develop a one-size-fits-all corporate wellness program for every company. A well-designed program will improve participant health, well-being and engagement, enhance morale, productivity and safety, boost organizational performance, support recruitment and retention and contain costs—but only if it’s customized to meet the needs and interests of the employees and address the goals and objectives of the company.
At PBM, our health risk management consultants perform a strategic analysis of your workforce and emerging markets, so we understand your company’s unique demographics, employee benefits, communication practices and culture. Then we design, implement, measure and evaluate a sustainable program that addresses those factors while keeping compliant. We’ll give you a strong foundation for a successful program based on best practices and these proven principles:
5: HR Technology
We offer secure automated systems designed and maintained by leading benefits administrators that let you combine online plan enrollment and selection, client-branded benefits portal, employee communication, data transfer and consolidated billing workflows to maximize your productivity.
We will help you with the vendor research and request for proposal process, implementation and vendor monitoring for services including:
- HR information systems—employer access
- Payroll interface
- Leave management
- Performance/talent management
- Benefits administration
- Online enrollment
- Self-service—employee and/or management
- Recruitment
- Time and attendance
- COBRA administration
- Consolidated billing
- International employee benefits assessment
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Mergers and acquisitions
- Pre-close due diligence
- Post-close transition planning
- Global help desk
- Multinational pooling
- Benefit plan benchmarking
- Benefit plan design and financing
- Global and local benefit plan management
6: Global Benefits
We are a proud member of the Globex International Group, along with 300 other independent international brokers and agents in more than 130 countries. Globex is the leading independent multinational risk management, insurance and employee benefits service organization. Through Globex, we have access to experienced insurance professionals located worldwide who can deliver the same health and welfare insurance products and services internationally as we do domestically, allowing us to provide local service across the globe.
We also employ an in-house professional certified in global benefits management to serve your expatriates, inpatriates, third country nationals and key employees that travel abroad. If you offer employee benefits internationally, we will partner with Globex to centralize your plan design, brokerage, plan implementation and administration services. We coordinate services on a global scale based on local trends, customs, benchmarks and regulations, country profiles and case studies.
7: Compliance
There is nothing required by the Employer that PBM does not provide.
Employee benefit plans are governed by an increasingly diverse number of state and federal regulations, and with Health Care Reform, new rules are on the horizon. Plus, those you may already be familiar with can change.
We can help you interpret and comply with new and emerging rules under Health Care Reform legislation, ERISA, HIPAA, COBRA and many other relevant regulations. Not only do we proactively communicate new legislation, regulations and upcoming deadlines, we reactively address your compliance concerns and special circumstances.
Many Employers rely on their health plan broker to keep them compliant. We monitor legislative activity to explain the impact of new rules on your benefit plans and provide assistance to audit your documents and policies for vulnerabilities with the direction you need to remain compliant. We help you control risk and limit liability by reviewing your company’s compliance in multiple key areas.
Employers offering qualified benefit plans are required to file the Form 5500 every year. The data collected provides pertinent information to the Department of Labor for help in assessing employee benefit, tax and economic trends and policies. It also assures that benefit plan management meets prescribed standards. Correctly preparing and filing the Form 5500 requires dedicated time, labor and knowledge of applicable IRS and DOL requirements.
Using ERISA-approved software, we help you satisfy the electronic filing mandate for your Form 5500 with ease and accuracy. We gather the necessary information to prepare your signature-ready Form 5500 and associated schedules, electronically file them and draft the requisite Summary Annual Reports that must be distributed to plan participants.
Employee benefit plans
- ERISA (including plan documentation like SPDs/Wrap Documents)
- Affordable Care Act
- HIPAA
- COBRA
- FMLA
- IRS Sections 125 and 105
Human resources
- Record retention policies
- Employee handbooks/manuals
- Policies and procedures (including sexual harassment)
- EEOC issues
- FLSA/Wage & Hour issues
- FMLA issues
General business
- Loss control
- OSHA
- Workers’ Compensation experience modifier
- Workers’ Compensation claims review
- Contract review
- Risk transfer
- Replacement cost/building ordinance
- Business income
8: Cobra Admin
If you employ more than 20 individuals during 50 percent of business days, then you’re required to offer them COBRA coverage after a qualifying event that causes a loss of health coverage or change in the level of coverage provided. The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to continue the benefits provided by your group health plan for limited periods of time.
If you’re an Employer in Arkansas with less than 20 employees, the state requires you to offer something similar to COBRA that’s often called “State Continuation.” If you have more than 20 employees, Arkansas requires you to offer an additional extension of coverage after a former beneficiary’s COBRA coverage ends.
Because COBRA rules change frequently and regulations are time-sensitive, you face challenging administrative issues and noncompliance penalties. Outsourcing your administration to PBM certified COBRA Administrators helps you.
Reduce utilization and claims—we monitor compliance to ensure that only eligible participants remain on your plan
Reduce administrative costs—we reduce the amount of time and resources you spend on COBRA related tasks by deploying a web-based system that produces and sends
Required COBRA notifications, bills, collects and distributes premium payments, reports eligibility and generates monthly premium statements.
Maximizes compliance and minimizes liability—we accept responsibility for all work performed on your behalf and indemnify you for all direct, monetary and compensatory damages if we fail to provide the agreed compliance services.
9: FSA/HRA Services
PBM performs several administrative functions for your employee benefits program through on-staff professionals. Because we provide these indispensable services in-house, you can save on vendor fees and reduce the time required to manage third party administrators—freeing you to focus on your core competencies.
Flexible Spending Accounts (FSA)
We guarantee timely administration of your Section 125 reimbursement plan with a 24- to 72-hour turnaround on claim checks via direct deposit and provide your employees with online access to their account balances. Debit cards are also available to your employees for the electronic transfer of pre-tax dollars to pay for qualified health care and childcare expenses.
Health Reimbursement Arrangements (HRA)
We manage reimbursement of claims within 48 hours of receipt with an Explanation of Benefits from your insurance carrier. Reimbursement options include direct deposit or payment to the health care provider, and employees have online access to their account information through our WealthCare portal.
10: Concierge Services
Everyone is familiar with Concierge services at a hotel front desk. Medical concierge services provide a patient service representative that assists members and their families with resources pre and post admission for treatment with high dollar claims. This model is an engagement tool that helps reduce utilization and costs to members while navigating them through the processes of seeking treatment and setting up post op or their home care needs.
11: EAP: BENEFIT BASICS
Employee Assistance Programs (EAP) are available to help when you need information, resources, advice or guidance during life’s many challenges. Whether you’re planning a move or planning for college, need financial guidance or budgeting tips, dealing with the aftermath of death of a loved one, or just simply need help finding quality childcare or reliable elder care for your loved one, and much more. An EAP Program is a confidential resource to your employees and just a phone call away and ready to help.
12: Medicare Specialists
In today’s workforce many employees are working past retirement age. With the complexities of the Medicare puzzle (A, B, D, etc.) and the group health plan options we provide Medicare specialists that assist employees and their spouses that need help navigating through the process and their healthcare needs
13: Pharmacy Audit Services
Provides a detailed analysis of your pharmacy claims data whether your plan is fully or self-insured. The contract review by Pharmacy contracting Attorneys help you interpret the complex pharmacy terms within your contracts that explain what you actually pay for each pharmacy claim. This service equips Employers, as their health plan Fiduciary, to make more informed decisions that affect their plan performance and reducing their pharmacy costs.
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