Employee Benefits

Employee benefits are at the core of the company’s productivity and staying power.

At Seguí & Associates (S & A) we first assess your ideal benefit package and discuss alternatives for structuring employee benefits in ways that incentivize your workforce to excel. Once we have a clear course of action, we go to the market to shop around and get you the best coverage and service deals.

Some of the general insurance services we regularly extend to our clients include:

Group and Individual Health Plans
Group and Individual Life Insurance
Long Term Disability (LTD)
Short Term Disability (STD, Act 139)
401K / 1165e – Pension Plans
Cancer Care and Voluntary Benefits
Disability Management Programs
Human Resources and COBRA Administration
Medicare Advantage

Let us do the walking and the talking, while you focus on what you do best: making your business grow.

Services Provided to Clients

Review of plan documents, policy, endorsements and/or policy amendments
Notification of governmental reporting and disclosure requirements. Assistance in the completion and submission of said forms.
Analysis of programs, including benefit plan design and cost estimates with submission of our recommendations to the management
Meetings with employees to explain plan features or changes
Periodic review on the status of health and drug claim experience and forecasts
Periodic experience reports (as needed) that show trends, per capita cost, and experience comparisons of previous years
Monthly/periodic meetings with the client to identify and address problem areas, as they arise
Financial audit of all Group Insurance Programs, premium level analysis, claims, reserves, retention (expenses – administrative charges), pooling charges/contingency reserves, and margin levels
Customizable healthcare financial premium alternative, including Fully Insured, Minimum Premium, and Administrative Services Only (ASO)
Stop-Loss insurance alternative, including specific and/or aggregate stop loss
Annual renewal meeting with a report of our findings and recommendations

At Seguí & Associates We Guarantee Results:

We ensure between 10% and 15% of sustained savings in your Group Health Plan and Employee Benefits Program.

Healthcare Claims Management

Healthcare Plan payment reviews – ensure the accuracy of claim adjudication and payment
To identify overpayment patterns that translate into an overuse of the healthcare plan
Payment recovery processes

Predictive Modeling

Likelihood of Hospitalization Model: Predicts the members that are more likely to be hospitalized in the next 6 to 12 months and their conditions.
High Cost Member Model: Predicts, for the next 12 months, the members of higher cost trend conditions that drive the cost and the predicted pm/pm.
DCG Model: Predicts high-impact conditions, the number of members per condition, and the “per employee per month expense” (pepm) of these members in the next 12 months.

Drug Claim Auditing (PharmaMedik)

Full-fledged drug use review
Dx vs. Rx utilization matching
High drug utilization pattern monitoring
Benefit abuse & fraud detection/management
Referral and catastrophic cases to Disease Management (DM) Programs
Drug formulary management consulting & drug program redesigned by mail order support

Coordination of Benefits

Coordination of benefits and Medicare secondary payer procedures
Identify members with other health plans; determine primary and secondary payers (savings could round from 3% to 5% according to group size)