Employee Benefits
Small Group Solutions
Large Group Solutions
Employee Benefit Solutions – Large Groups
Our mission is to ensure that your company’s large group benefits support your corporate goals.
At America’s Benefit, our mission is to ensure your company’s large group benefits align with your corporate objectives.
We achieve this by collaborating with clients to create, implement, and monitor customized strategies and solutions. We stay ahead in the industry by leading with experience-based recommendations and the latest technology.
We explore solutions such as contribution strategies, consumer-driven healthcare, renewal strategies, wellness initiatives, disease management, plan pricing, plan design, pharmacy management, and more.
We develop integrated, customized solutions by aligning your strategic objectiveswith our current program analysis.
Our Large Group Benefits Solutions
To deliver our benefits resources effectively to the middle market, America’s Benefit has developed large group bundled solutions. These solutions offer core brokerage and consulting services paired with value-added solutions to support our clients’s benefits programs and human capital investment.
We understand that the benefits program offered to employees is just part of a comprehensive human capital strategy, but we aim to ensure it is as impactful as possible.
Your employees are your top priority, and you need a benefits package that puts them first.
An experienced partner can help you understand your risk tolerance and budget when opting for a self-funded solutions model over traditional benefits.
Our team of experts at America’s Benefit is ready to help you build a self-funded benefits package that aligns with your company’s goals. Explore our suite of self- funded solutions.
Stop Loss & Funding Solutions
With our proprietary plan design modeling tool, we can evaluate multiple plan changes, assess the impact of plan and population changes, and provide insights on change drivers. This modeling is done in real time using actual client data during strategic meetings.
We estimate medical and prescription costs, determine funding rates, and project employee migration to new plan options using predictive models based on up to three years of past claims.
By employing advanced algorithms, we illustrate stop-loss risk/reward profiles, allowing us to identify optimal outcomes. This capability enables us to provide reliable forecasts within a defined confidence interval, supporting our client’s budgeting needs.
For our fully insured clients, these tools allow us to engage in our unique “reverse renewal” process and evaluate the feasibility of remaining fully insured versus exploring self-funded alternatives.
Pharmacy
The pharmaceutical landscape is constantly evolving and becoming more expensive with the introduction of new drugs for various conditions, specialty biosimilar options, and gene therapy treatments for rare and complex diseases.
On average, the prescription drug benefit represents 25% of a plan’s total health expenditures and is becoming the largest healthcare cost.
Given these factors, it is crucial to have a dedicated and experienced pharmacy management team providing focused resources and consulting to plan sponsors.
Our Pharmacy team consists of seasoned professionals with hands-on experience, specialized training, and the knowledge needed to navigate the complexities of today’s healthcare environment.
Our team includes subject matter experts in every area of pharmacy management: financial, clinical, operational, contracting, reporting, and analytics.
America’s Benefit Rx Advisory Services include:
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- PBM contract review
- Baseline evaluation of current terms and programs against high-performing plans
- Utilization performance benchmarking
- Review of all trend & clinical management programs being offered for a plan’s consideration
- Plan design and cost-share modeling
- Full Rx market evaluation – Request for Proposal process
- Full financial, clinical, and administrative technical scoring
- Conduct finalist presentations
- Contract renegotiations and finalization of contract terms
- Implementation support
- Ongoing consulting support to the account team
- Quarterly and annual performance reviews to include:
- Plan design
- High claimant strategy
- Clinical program performance
- Trend management opportunities
- Key performance indicator reports
- Recommendations for consideration
- Reconciliations of financial discounts and rebate guarantees
- Monitoring and review of all performance guarantees
- Full PBM audits of contract terms, plan administration, and manufacturer rebates
Large Group Bundled Solutions
America’s Benefit has designed specialized services within our Employee Benefits practice to address the diverse needs of our clients.
These solutions are crafted to provide core brokerage and consulting services, enhanced with value-added options to support our client’s benefits programs and their human capital investments.
When collaborating with our benefits teams, clients gain access to our comprehensive resources to tackle even the most complex human capital challenges.
We leverage our extensive industry expertise and analytics to ensure that our customized benefit solutions align with our client’s culture and offer the highest value to their employees and the company.
Experience Power through Partnership.
Large Group Bundled Solutions Scope of Services
Large Group Bundled Solutions Scope of Services
Consulting & Analytics
Population health management analysis
Medical and Rx analysis
Plan disruption analysis
Forecasting and predictive modeling
Data warehouse with 20 million member lives
Plan design and funding analysis
Pharmacy & Analytics
Custom PBM and clinical programs
Pharmacy coalition drug purchasing tool
Clinical care management
RFP / vendor selection
Contract review and negotiation
Market check analysis
Brokerage
Benchmarking
Plan design
Plan comparison
Negotiate renewals
Employee Advocacy
Employee call center
Escalated claims resolution
Dedicated 800 number and email
Liaison between employee and carrier
Telephonic support for over 200 languages
Plan design and funding analysis
Employee Health Management
Health and wellness assessment
Health management strategic planning
Wellness program implementation, coordination, and evaluation
Wellness service provider acquisition
Wellness platform
Executive Benefits
Executive benefit plans to attract top talent
Retirement plans
Business succession planning
Wealth preservation
Life and disability plans
Executive long-term care
Communications
Communication strategy
Branded benefits guide, i-guide, postcard, poster
E-mail branded announcements
Health & wellness newsletters
Wellness program communications
Mailing & fulfillment center
Compliance
ERISA attorneys and compliance team
Health care reform guidance
Plan documents and SPDs
Initial compliance audit
Signature ready 5500s and SARs
Notification of legislative changes
Wellness program compliance
Benefits Administration
Online enrollment platform
Eligibility and billing administration
Consolidated billing
FSA, COBRA, HRA administration
Real-time administration panel, employee portal
Mobile apps
Let’s explore Employee Benefits solutions for your business.
Employee Benefits Blog
2025 Out-of-Pocket Maximums: What You Need to Know
Welcome to America’s Benefit! We have some important updates regarding the out-of-pocket maximum limits for 2025, straight from the Department of Health and Human Services (HHS). These changes are essential for managing your healthcare expenses effectively. Let’s dive in.
Key Updates for 2025
Individual Plans
Starting in 2025, the out-of-pocket maximum for individual plans will increase. This means you’ll need to budget a bit more for your healthcare costs. Staying informed helps you plan better and avoid unexpected expenses.
Family Plans
Family plans will also see a rise in their out-of-pocket maximum limits. This adjustment is crucial for families to manage their healthcare budgets and ensure they are prepared for any medical expenses that may arise.
Why This Matters
Understanding these changes is vital for making the most of your healthcare benefits. By staying informed about the latest updates, you can better manage your healthcare costs and avoid surprises.
Action Steps
Review Your Plan: Check your current healthcare plan and see how these changes might affect you.
Adjust Your Budget: Plan ahead for the increased out-of-pocket maximums to avoid any financial strain.
Stay Informed: Keep up with the latest updates from HHS and America’s Benefit to ensure you’re always in the know.
For more detailed information, schedule a call with Ron Stromple.
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