There are many reasons a company may determine that it makes sense to self-fund its medical plans. When compared to traditional fully-insured plans, self-funded programs can offer several advantages including: - Control over benefit offerings
- Control over rates and funding options
- Elimination of state-mandated requirements
- Flexibility in offering multiple plan choices
- Reduced fixed expenses
- Control over unbundled components
- Custom reporting
- Stop loss protection based on risk tolerance
- Improved claims management and control
SOMI offers comprehensive services in the design and administration of medical plans. We can work within existing plan designs or help design new plans to meet your needs. Our services include the ability to: - Design and build your plans on our claims systems
- Manage and contract with all plan vendors such as Preferred Provider Organizations (PPOs), Pharmacy Benefit Managers (PBMs), Stop Loss, Utilization Review (UR), specialty services
- Assist in rate and financial guidelines for appropriate funding
- Handle all enrollment and eligibility loads and feeds
- Draft legal plan documents and on-going amendments and plan changes
- Produce ID cards and required forms
- Coordinate transition from current administrator
- Perform enrollment meetings
- Implement legal updates and legislative requirements
- Integrate claims processing with Ingenix and PPO partners
- Perform EDI transmission and receipt
- Integrate with and monitor PBM
- Provide trigger diagnosis reporting and disease management program
- Manage coordination of benefits
- Prepare and manage appeals
- Provide maternity and specialty care management
- Present monthly claims and analytical reports
- Offer multiple funding options
- File 1099s
- Prepare 5500 tax forms
For more information about our medical and dental solutions, visit the following links:
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