Employer Services

Professional Benefits Services is your one source provider of administrative services for self-funded medical, prescription drug, dental, vision, flexible spending accounts, COBRA and retiree outsourcing. From enrollment to receipt and payment of claims, our management staff and skilled claims analysts are dedicated to employer satisfaction. Sophisticated internet technology allows employers to view claims and balances online and check payment status. Live phone attendants, access to national vendors and customization make PBS unique in the market place.

IT’S TOO LATE TO RUN, MEDICARE D IS ON THE BENEFIT HORIZON

by Linda Damon

On the now recognizable horizon is the much talked about, highly anticipated, prescription drug addition to the Medicare stable of benefits. We are fast reaching a time when every email and piece of paper arriving in your IN basket will be delivering various versions of “all you need to now about MEDICARE D.”

Depending on the source, much of this information can be conflicting, confusing and downright scary. If your head is spinning, eyes glazed over, and you never really enjoyed the pure excitement of government regulations, guidance and filing deadlines, don’t be discouraged. You are like most of the HR/ Benefit professionals and mere mortals churning up the gray matter of understanding. And, this is only the beginning.

Sometime, before November 15, 2005, your office must make critical decisions of “creditable” or “non-creditable,” determine actuarial equivalence, dicker with actuaries, apply for subsidy or not, look at “wrap”designs (make mine a veggie) and develop a major communication campaign for your retirees.

Now, the one bright spot in all of this is that you may have the chance to capture some savings in your prescription drug costs, delight retirees with a better plan and generally develop a really close and enriching relationship with your TPA.

We are told that many employers are opting to collect the subsidy. With this option, they will not have to change their plan, if it can be actuarially attested to be equivalent with Medicare D (which will make beneficiaries, who hate change, excited; and simplify communications), but don’t forget the trade off is accepting an unlimited 95% payment obligation on catastrophic claims. That may be less painful, though, than the application and 12-month long filing for subsidy process. Frankly, if you didn’t attend the Subsidy conference put on by the newly formed RDS Center, held in Dallas during July, you will be challenged trying to follow the book version. The RDS technical developers are magnificent. They have considered every possible detail, turned over every rock, and thought through the remotest of possibilities at a primitive gut level. Nasa would be envious of the web based system RDS have developed to accept, investigate, discover, track, approve, gather, store and authenticate the myriad of data necessary in filing for the subsidy. Remember, there is no “free lunch.” The subsidy process is complex and time consuming, and may even generate some cost to get the appropriate reports from your carriers . . .if, in fact, your carriers are capable of splitting out Rx from your plan.

What’s an overworked, understaffed HR Executive to do? Most PBM’s and carriers have announced they will not provide a subsidy filing service. We’re not sure the major benefit consulting names are interested in helping, but we are sure their prices would be hefty and could eat up a significant portion of the subsidy. A Midwest TPA, located in Grand Rapids, Michigan is offering a full array of Medicare D services including plan selection and enrollment, retiree billing, Subsidy application, administration and filing processes. They will design and implement Medicare D wraps, maintain all government compliance, determine creditability of current plans and notify all Medicare eligible beneficiaries. Professional Benefits Services will also develop a full communication package and conduct onsite meetings with retirees. Complementing these Medicare D services are turn-key retiree outsourcing services providing Medicare Medical Supplements and a retiree service and advocacy center. The Professional Benefits Services Retiree Service Center is staffed by trained, compassionate professionals skilled in communicating with senior adults. Their personal pledge promises no call will ever be answered by a machine.

Medicare D is certain to be under construction this whole first year as CMS staffers and contractors refine and implement the suggestions from public opinion. All of the originators who have worked long hours, sweat tears and are giving birth to Medicare D in a miraculously short gestation period have it’s success seriously at heart. The teamwork that has been required from groups of people who never knew each other before, but now share the awesome task of parenting the Medicare D infant, is nothing short of amazing,. We here at Professional Benefits Services wish this Medicare program well, and stand ready to assist employers to a successful transition from traditional RX cost burdened plans to the new Medicare D cost sharing options.