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BCI Consumer Solutions Details

Group Medical Benefit Plans
At BCI, we pride ourselves on being your “one-stop shop” for comprehensive benefit solutions. A major part of our solution is establishing and retaining key partnerships with trusted carriers who deliver exceptional products to meet our clients’ needs. With literally hundreds of different plans from which to choose, BCI will offer the most appropriate plan(s) to meet your particular benefit needs. Each plan contains its own unique structure in terms of overall plan design, deductible, co-payment and/or coinsurance, provider network(s), utilization management, and potential for utilizing or adding a Flexible Spending Account (FSA), Health Reimbursement Account (HRA), or Health Savings Account (HSA).

Featured Ancillary Lines of Coverage
BCI’s goal is to be your single source for employee benefit products. We maintain relationships with all major carriers in our market areas and constantly scan the market for new products.

The strategy behind BCI Consumer Solutions involves the inclusion of one or more ancillary lines of coverage to achieve a complete, comprehensive benefit package. All proposals feature the following standard lines of coverage. Plan designs and products other than those quoted are available upon request.

Dental Plans
BCI has many different fully insured dental products. Dental plans can be offered with varying benefits, including deductibles, co-payment and/or coinsurance, annual maximum, and provider networks.

Available plan designs include:

• Traditional Indemnity Plans (many using passive Preferred Provider Organizations)
• Preferred Provider Organization (PPO) Plans
• Dental Maintenance Organization (DMO) Plans
• Discount Card Only Program

Life/Accidental Death and Dismemberment (AD&D) Plans
BCI has a broad selection of carriers from which to choose a Group Term Life/Accidental Death and Dismemberment (AD&D) Plan. Benefits can be offered as a basic or supplemental line of coverage. BCI will help you select a group term life policy with supplementary AD&D coverage for your employees, and can extend benefits to dependents as needed.

Short Term Disability (STD) Plans
Many health plan sponsors also offer Short Term Disability (STD) Plans. Policies can have variations in plan design to suit your particular income replacement needs, including:

• Choice of maximum benefit amount paid weekly or monthly, set up as percentage of regular earnings, fixed dollar amounts, or combination of both.
• Selection of elimination periods for disability due to illness and/or injury.
• Choice of maximum length of benefit period.

Integrated Technology Package
As part of our BCI Consumer Solutions strategy, we seek to give plan sponsors tools that simplify and streamline plan management in a seamless manner. To achieve our goal, BCI provides the following services in conjunction with the purchase of any medicalplan and one ancillary line of coverage:

Consolidated Billing

• Generation of a consolidated bill, including all lines of coverage for all carriers placed through BCI, where applicable.
• Provision of line item detail of every covered employee including the benefit plan selected, effective date, coverage level, and premium charge associated with each benefit.
• Customization of billing rates (e.g. benefit specific rates, composite rates, rates unique to each client location, and age-banded rates).
• Allocation of premium billing by divisions and further by departments, if needed.
• Coordination of all carrier and vendor payments, where applicable.
• Management of any eligibility reconciliation issues.

Full Service Customized Group Benefits Website

• Creation of full service, customized eServices website, including links to carrier and network websites as well as informative health and wellness websites.
• Provision of independent views of elected benefits.
• Creation and maintenance of an online benefit summary.
• Accessibility to identification card request system.
• Ability to submit questions to customer service department.

Benefit Statements

• Production and delivery of benefit statements.
• Optional customization of benefit statements to include all employer-contributed and voluntary benefits, including 401K, vacation time, and any other employer-sponsored benefit. Additional charges may apply for customization.

Online Enrollment

• Online capability for employees, with employer approval, to elect benefits during initial enrollment period as new hires or during open enrollment, change coverages due to a life event, and update demographic information as needed.
• Maintenance of comprehensive audit trails for all enrollment and eligibility transactions.

Carrier Eligibility Data Interfaces and Reconciliation (if applicable)
BCI establishes and maintains electronic data interfaces with each carrier in order to accurately and efficiently ensure that all eligibility additions, terminations, and changes are updated for each line of coverage with each carrier. Our team is responsible for managing and auditing eligibility through carrier bill review and electronic eligibility reconciliation.

Eligibility Management
BCI can take in virtually any eligibility file that contains all of the required data elements and load it to our claims system, including transactional 834 files, full 834, XML eligibility files, and proprietary flat files.

• ­Both eligibility and claims processing are maintained by our claims system.
• ­BCI updates eligibility daily.
• ­BCI has the ability to send daily eligibility files to vendors, i.e.: RX, UM.
• ­BCI's eServices does provide a listing of eligible employees online and is updated daily.
• ­Our claims system stores historical eligibility information such as: dependent data, other coverage, name, address, e-mail address, division, class, department, date of hire, effective date, gender, and date of birth.
• ­Eligibility can be loaded by division, department, plan of benefits, and any subset required.

Health Advocate™
Health Advocate, BCI’s partner providing health care advocacy services, is an organization whose mission is to specifically address many of the problems routinely confronted when accessing healthcare services and health insurance coverage.

Health Advocate services include:

• Assignment of a “Personal Health Advocate,” who is always a Registered Nurse, to serve each member when first accessing the services. Members can contact their Personal Health Advocate 24 hours a day, 7 days a week, to seek answers to any clinical or benefits related administrative issue, discuss resources and choices, or coordinate care among physicians and medical institutions.
• Additional support of the Personal Health Advocate provided by a team of physicians, benefits experts, and administrative professionals.
• Management of health plan cost containment and member satisfaction through Health Advocate’s major objectives for member advocacy services. These objectives are to:
  • Engage members in their health care decisions and help them make wise treatment choices
  • Direct members to the right information at the right time
  • Facilitate member decisions when there are multiple treatment options
  • Help members select appropriate medical providers for the care they require
• Ability of parents and parent in-laws of the eligible employee to additionally access Health Advocate’s services.

HR Administrator Reference Desk
To further promote understanding of the regulatory environment facing every Human Resources Manager, BCI has partnered with Benefits Essentials to provide you with an HR Administrator Reference Desk.

The HR Administrator Reference Desk is an award-winning, comprehensive resource and reference center containing a library of information on employee benefits, human resources, employment law, tax, and personal financial planning. This site features a vast database of numerous resources including sample forms, checklists, and model policies and documents (Note: For forms specific to your benefits or to customize materials for your benefits, contact your Broker or BCI Group Sales Executive). In addition, links are provided to numerous government sites for further information and model forms for compliance with state and federal laws.

Flexible Spending Account (FSA) Administration
A Flexible Spending Account is an employer-sponsored group plan that is a vehicle for tax-favored treatment of qualified expenses of your employees and/or their eligible dependents that are not reimbursable under another plan. Because the BCI Consumer Solutions approach fully embraces the use of consumerism to drive cost containment, we include FSA Administration for Premium Conversion Plan, Healthcare Spending Account, and/or Dependent Care Spending Account Plans as a core element.

BCI’s full-service FSA Administration features:

• Creation of plan document, summary plan description, and compensation reduction agreement (online or hardcopy) for chosen lines of coverage.
• Provision of communication materials to enhance employee understanding and increase enrollment.
• Management and reporting of account balances and funding.
• Disbursement of payments for eligible expenses.
• Application of non-discrimination testing.

COBRA Administration (where applicable)
COBRA Administration is one of the most complex health plan administrative responsibilities due to the stringency of notification requirements and the ever-changing nature of COBRA law and interpretation. By leveraging BCI’s expertise in COBRA Administration, plan sponsors will save countless hours in administrative tasks that fall outside their core competencies.

Our COBRA Administration includes all of the following services:

• Initial notification of COBRA continuation rights to all newly eligible employees and spouses.
• Provision of monthly payment coupons to COBRA participants.
• Sending of subsequent reminder letters in the event payment is not made timely.
• Notification that the right to elect continued coverage has expired.
• Notification that coverage is terminated.
• Maintenance of all records needed in the event of a COBRA complaint and handling of all communication with the Department of Labor.
• Billing, collection and remittance of premium. The customary 2% of premium will be added to the billed premium in all instances, and will be retained by the carrier or BCI.

HIPAA Administration
The goal of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) was to provide employees the right to receive credit for coverage under a prior plan, with respect to pre-existing condition limitations, an exclusion found in most major health plans. Due to the complexity of the law, the administration of HIPAA requires a staff that is frequently updated on the latest legal interpretations and implements procedures to meet HIPAA administration guidelines. BCI has been a pioneer in HIPAA Administration and continues to lead the way with our unique approach.

BCI will complete all of the administration in order for your company to comply with the Health Insurance Portability and Accountability Act. Our experienced staff will review and verify the accuracy of certifications and calculate employees’ creditable coverage. Our HIPAA Administration staff’s first duty is to furnish certificates of creditable coverage to terminated employees. If BCI is providing COBRA administration for the client, a certificate of creditable coverage can be included with the initial COBRA packages. Otherwise, a HIPAA certificate will be sent directly to the employee, including pertinent dependent coverage information.

In addition, BCI determines which employees and/or dependents may be subject to pre-existing condition limitation of the plan and pro-actively sends notification. Upon receipt of a certificate of creditable coverage, the appropriate credit that should be applied to each employee and/or dependent’s pre-existing condition period is calculated.

Employee Call Center
BCI will provide an Employee Call Center staffed with Customer Service Specialists trained expressly in the plans offered by an employer. The Customer Service Specialists have online access to all of the employees’ benefit information and are responsible for first tier call resolution. They will work with the caller to address any basic benefits questions, specific claim status, or claims determination questions. The Employee Call Center is currently equipped to handle both Spanish and English speaking callers.

Specialized Support Team
We have developed a distinctive unit of personnel uniquely trained in all insured group plans and the administrative services associated with BCI Consumer Solutions to provide a single, comprehensive source for customer service issues.

Each plan sponsor is assigned a Specialized Support Team, consisting of a Group Sales Executive, Group Service Representative, and Client Accounting Services Representative.

• The Group Sales Executive will assist you in choosing the best products and services, at inception and on an ongoing basis, to meet your benefit needs.
• The Group Service Representative helps you manage all the details of your implementation and transition process. In addition, they will conduct employee meetings upon request (additional charges may apply for travel and transportation costs associated with employee meetings). These specially trained individuals are also responsible for answering our Small Group Solutions hotline, which is dedicated to plan administrators and their advisors.

The Client Accounting Services Representative is appointed to handle implementation of your plan and the ongoing maintenance of billing and eligibility.