Health & Group Benefits Consulting
CMC actuaries and consultants provide a wide range of services to help our clients effectively manage their employee and retiree benefit programs. Working with an extensive variety of public sector employers and plans gives us the unique vantage point to follow trends and know what will, and will not, work in the public sector. Some of the services we provide are listed below. Please follow the links or contact Alisa Bennett (678-388-1703) to discuss how we can help you more effectively and efficiently deliver medical, prescription drug, dental, vision, disability, life, vacation and other benefits to your employees and retirees.
Retirees and active employees clearly have different benefit needs. CMC is experienced in designing benefit and contribution strategies tailored to active employees and retirees of public sector plans. We can help you design an effective benefits program to recruit and retain the best employees and provide benefits in the most cost effective and administratively efficient manner possible, now and into retirement.
Many employers — private and public — have introduced consumer driven health care (CDHC) plans, on both a total replacement basis, and as an additional plan option. If executed properly and in conjunction with other efforts, a CDHC plan can contribute to healthier employees and retirees who are more engaged in their health care decisions and generate claims with lower annual trends. CMC has implemented many CDHC plans for governmental employers. We can help you choose a Health Savings Accounts or Health Reimbursement Accounts strategy, as well as the number of plan options and the option design to distribute and stabilize risk.
CMC actuaries and consultants have extensive experience in establishing funding rates and premium equivalencies that result in effective funding and budgeting of self-insured employee and retiree benefits. We work with employers that self-fund medical, prescription drug, dental, vision, life, disability and even long-term care.
CMC actuaries and consultants understand the complexities and nuances specific to budgeting, funding and financing benefit plans in the public sector. We help our clients by establishing rates — whether defined as a percent of active pay, as a flat per employee rate, rate(s) that vary by coverage option or possibly by employee group — that lead to healthy funding levels and the most cost-effective delivery of benefits possible.
CMC actuaries can recommend ways for plan sponsors to develop adequate reserves to fund outstanding claim liabilities for Incurred but not Reported (IBNR) claims for self-funded plans. We can estimate claims reserves for your medical, prescription drug, dental, vision, disability and long-term care, vacation and paid-time off benefits.
CMC actuaries and consultants have the experience necessary to help you design a contribution strategy that fits your benefits philosophy. We can adapt that strategy to all the important variables, include employment status, dependent coverage, tier structure, plan election, service, salary and location. Just as important, we’ll ensure that the schedule is accurately and properly reflected in the budget.
Finding the right partners is critical to designing a benefits program. For self-funded benefits, it is imperative that the claims administrator(s) are able to administer the plan as designed and do so as efficiently as possible. For insured benefits, finding a carrier that can effectively manage the risk and provide stable premiums from year to year enables an employer to more effectively manage its benefits budget. In both cases, vendor partners should provide your employees and retirees with access benefits, information and conflict resolution. CMC actuaries and consultants have extensive experience and industry contacts to help you conduct a vendor search and manage existing vendor relationships.
As new drugs come to market at a rapid pace, staying on top of your pharmacy benefits design has never been more difficult. CMC actuaries and consultants have the experience and expertise to help you develop an effective program that is up-to-date with today’s most effective and efficient treatments and that reflects differences in needs between active employees and retirees (i.e., senior-specific formularies). We can review utilization patterns, modify your copay structure, analyze your utilization review programs, and introduce specialty programs. If you do not have clinicians or pharmacists on staff, we have a strategic partnership with a leading pharmacy benefits consulting firm and can put those resources to work for you.
When it comes to managing the costs generated by employees and retirees with chronic conditions or catastrophic illnesses or events, the “80/20” rule (20% of the membership generating 80% of the claims costs) seems to reflect reality. Most administrators and insurers have their own, in-house programs. These have the advantage of providing care and case managers more direct access to providers, but there are benefits to hiring an independent outside vendor to provide these management services. After a careful evaluation of your claims, utilization experience, and available programs, CMC can help you determine which program, or combination of programs, may best suit your needs.
While most employers feel the need to “do something” around preventive care and wellness, most of these programs come with an up-front cost (either in hard dollars or in staff commitment) that is quantifiable, but come with benefits that are less quantifiable. While it is difficult to argue against programs that lead to healthier employees and retirees, care needs to be taken so ensure that the limited resources available for these programs both create a benefit and reduce future claims costs. CMC can conduct a careful analysis of demographic and claims data to help you determine the most effective way to help your employees and retirees lead healthier lives.
Retiree Drug Subsidies (RDS), Prescription Drug Plans (PDPs) and managing the OPEB and GASB implications: simply put, the options are as complex as the acronyms. However, CMC can provide a careful comparison and evaluation of all alternatives is needed to make the best decision for your plan and retirees. CMC actuaries have conducted many such analyses for state and local governmental plans and employers.
Providing your employees and retirees access to benefits on a group basis is an effective way for them to purchase additional coverage (i.e., life and disability buy-ups, etc.) or have access to benefits that would otherwise be more costly for them to purchase on an individual basis (i.e., auto insurance, basic legal services, etc.). CMC actuaries and consultants have the experience and industry contacts to help you offer your employees these voluntary benefits.
Whether you want to provide a wide range of benefits, or just need to establish a Section 125 plan in order to offer a Flexible Spending Account, we have the skills and experience to help. These additional plan choices and employee/retiree contributions must be designed so that risk and employer costs can be stable on a year-to-year basis. CMC actuaries and consultants have the skills and experience needed to help you design a cafeteria program that provides the choice your employees want and the economy you need.
Having enough providers in your medical, dental and vision networks is not enough. Having quality providers that are geographically accessible to your employees and retirees is more important. Whether you just want to evaluate your current network, or are looking to expand, change or replace your network, CMC actuaries and consultants have the experience and skills needed to ensure your provider network is the one best suited for your benefits program.
Risk that is not measured cannot be properly managed. CMC can measure risk among your various plan options, demographics, claims, episodes and for the program as a whole. Once a proper risk profile is established, CMC can recommend changes to your program and contributions, if any are needed. Our work also can help generate relatively stable enrollments from year-to-year, which enables predictive budgeting. CMC actuaries and consultants have the experience necessary to properly measure your risk, develop useful risk profiles, recommend any needed program changes and accurately predict any enrollment migration.
While costs associated with chronic conditions or catastrophic events are fairly easy to measure, costs associated with increased sick leave utilization and reductions in productivity are much harder to quantify. CMC actuaries and consultants can help you take stock of your care and disease management programs and evaluate how well they work in conjunction with the return- and stay-at-work components of your disability programs.
While most of our clients deliver Long-Term Disability (LTD) and Long-Term Care (LTC) benefits on an insured basis (and often on a voluntary basis as well, for LTC), we work with several state-level plans that have sufficient membership to self-insure their LTD and/or LTC programs. This puts CMC in a unique position to help you determine if your program is a candidate for self-insured status and, if so, to determine the proper funding rates, reserves and OPEB liability, and required contribution(s) under GASB. In either case, we have the experience and expertise needed to ensure your administrator or carrier is effectively and efficiently delivering benefits to your employees. Since most commercial LTD plans are priced under the assumption that Social Security will provide a benefit that can be used to offset the employer-provided gross benefit, this can create unexpectedly high benefit levels. CMC’s public sector experience ensures this is considered in the design phase and that proper reserves and assets are generated by the contributions. We also ensure that your STD programs will effectively coordinate with the LTD and LTC programs so there is no gap in coverage between programs.
A periodic review of your program administration is important to spot discrepancies before they become ongoing problems or to provide peace of mind that all is running as it should. This is true for internal practices as well as those “farmed-out” to outside administrators. CMC can provide an independent third party review of your internal practices as well as claims administrator(s) to ensure claims are being processed in compliance your contract(s). We have experience auditing medical, prescription drug, dental, vision and all other claims and benefit administrators.
When you have concerns or an interest in the potential impact of proposed legislation on your plan, CMC is available to testify on your behalf before legislative bodies and committees. We are known for our ability to clearly explain complex concepts and alternatives and help you prevent the negative impact of unintended, or unforeseen, consequences.
CMC helps you understand the consequences (sometimes, unforeseen) of pending legislation, so you can plan now for future changes. For example, legislation that affects retirement patterns can have a significant impact on your OPEB results as well as on the financing and delivery of your active employee and retiree health and other benefits. CMC actuaries and consultants are available to help you determine the magnitude of any direct, or indirect, effects of proposed legislation.
CMC actuaries can determine standard risk rates by considering the premium rates charged by other insurers offering individual health insurance coverage and using reasonable actuarial techniques to adjust these rates. Adjustments are based on differences in plan design offered to individuals compared with plans offered under the high-risk pool. These actuarially adjusted standard risk rates will be used to analyze premiums charged by the high-risk pool in relation to pre-determined benchmarks. CMC will ensure that as you develop benchmarks for your analysis, that you include the appropriate characteristics for each cell, as well as the correct thresholds and averaging standards.