Benefits Boot Camp

Syllabus

March 18, 2010

Benefits- History: How did we get here? Why does it matter?

Market Overview

    • Including Worker's Compensation & FICA

Medical Insurance

    • Types of Plans- HMO/POS/PPO/CDHP
    • Tax Advantaged Plans- HRA/HSA
    • Funding- Self vs. Fully Insured
      •  
        -Size
        -Stop Loss
    • Networks- Carrier Platform Differences
    • Market- Local vs. National
    • Disease Management & Wellness
    • RFP Process and Key Points

Prescription Coverage

    • Types of Plans- Co-pay vs. Coinsurance
    • Market- PBM
    • Carve-in vs. Carve- Out
    • Drug Categories
      -Generic
      -Formulary
      -Non- Formulary
      -Mail Order
      -OTC
    • Drug Classes
    • Funding- Self vs. Fully Insured

      • -Risk Predictability
      -Stop Loss

Dental Insurance

    • Types of Plans- DMO/PPO/Indemnity
    • Market- Carriers
    • Categories of Coverage

      • -Preventive
      -Basic
      -Major
      -Orthodontia
    • Reimbursement Schedules

Vision
    • Plan Types
    • Market
    • Reimbursement Levels
       

Disability/Life Insurances

    • Types of Plan
    • Categories of Coverage
    • Rating considerations
    • State Mandated Coverage (e.g.- STD-TDB)
    • Taxability

Voluntary Coverage

    • Types of Plans

Employee Contributions

    • Benchmarking
    • Section 125

Legislative Compliance

    • ERISA
    • COBRA
    • FMLA

Case Studies and Wrap-up