Benefits Administration

Eligibility Management | Common Billing Remittance | Integrated Dependent Eligibility Verification | Pre-Payment Claims Review | Customer Service Center | Communications

Administering employee benefit plans is both complex and time consuming to say the least! Coupled with the fact that most human resources and benefits departments are stretched to their limits, more and more employers are seeking ways to improve efficiencies in this area. Some of the typical administration tasks they perform include:

  • Collecting, maintaining and transmitting accurate and up-to-date employee enrollment and eligibility information to the insurance carriers routinely
  • Reconciling and validating changes on premium statements from carriers, third party administrators, etc.
  • Verifying eligibility of covered dependents
  • Providing timely and accessible customer service to employees regarding claims, eligibility, etc.
  • Communicating plan changes, new offerings, contribution changes and procedural changes, etc. to employees
  • Administering post-employment benefits including COBRA, retiree billing, etc.
  • Performing compliance relating to regulatory statutes such as: Affordable Care Act (ACA), TEFRA/DEFRA, Medicare D/RDS, FMLA, and GASB 45 just to name a few.

Benetech has developed a comprehensive program of administrative services to assist employees with the burdensome day-to-day task of managing their benefit plans.

By integrating cloud-based technology into our administrative solutions, employers can streamline internal processes; thus, gaining efficiencies and savings while gaining greater control of their benefit plans.

Benetech’s Plan Administration – A single source, end-to-end solution!

Eligibility Management

Benetech has developed a single tool that simplifies the burdensome and inefficient tasks associated with maintaining and transmitting eligibility to insurance carriers.

Benetech’s cloud-based benefits/eligibility management platform enables you to work smarter…not harder—providing you with accuracy, control, access, and efficiency. Worried about all the aspects of tracking employee elections and dependent information for compliance with the Affordable Care Act? This solution puts you back in control by allowing you to own your data!

How often can you trace a claim or coverage problem to an eligibility issue?

More times than not, problems arise because of inaccuracy or corruption of data due to a variety of reasons. Many organizations receive handwritten applications and end up either faxing the forms to multiple carriers or directly inputting the information to multiple carriers’ websites themselves. Either method can result in a mistake being made. This can be compounded by illegible handwriting-how often can a mistake be made due to being unable to read information on a form clearly or key entry mistakes?

Additionally, you've invested time, effort, and money to gather all this data and pass it on, but yet you don't own it! You've given control to a third party. Just think about it, if you had a limited window of time to change your carriers-realistically could you do it or would you be held hostage by your current carrier? When you need access to it, you can't receive it in a timely manner or it is not in the format you need; which forces you to request multiple reports just to piece together the information you were looking for.

The advantages are obvious:

  • Timely and accurate eligibility-Eliminate paper, time, and mistakes through online enrollment. HR has full review of enrollment information submitted.
  • Maintenance-Data stored online is current and easy to update or change.
  • Efficiently interfacing with carriers- Enrollment is electronically batched and transmitted to carriers frequently.
  • Access-Many standard reports available, or create your own, to run on demand that put you in control.

Producing quantifiable savings by:

  • Eliminating paper
  • Reducing HR time on administrative tasks without compromising member satisfaction
  • Streamlining administrative procedures

Simple to implement, easy to use, and affordable!

Common Billing Remittance

Our billing and reconciliation process ensures billing accuracy from your carrier.

How much money could you be losing by not validating your changes and reconciling your carrier bills monthly? The lack of timely reconciliation and validation of bills may prevent you from recouping credits due to carrier billing restrictions.

Whether you are a single employer or a consortium of employers, you can save by using our service to track, verify and reconcile the multitude of transactions occurring inside your various plans.

Since many carriers are using "pay as billed," you run a substantial risk of loss if you're not validating each and every debit and credit. If you have a high volume of changes this is a very difficult and tedious process. Oftentimes you are forced to use a series of spreadsheets just to track this.

Our system offers:

  • Generated transaction reports enable us to monitor and validate the additions and terminations
  • Systematic name-by-name comparison to verify total enrollment/eligibility accuracy
  • Billing statements that reflect true costs during the desired time period. These can also be used for tracking internal budgets and cost centers.

Integrated Dependent Eligibility Verification

Benetech’s Integrated Dependent Eligibility Verification validates that the dependents covered by your employees are eligible for the coverage—resulting in both healthcare savings and eligibility data that is accurate for IRS reporting (necessary as part of the Affordable Care Act).

We know that employees don’t always notify HR when life changes occur:

  • A young adult no longer eligible due to student requirements
  • A divorce or separation (which leaves a former spouse covered)
  • A deceased child or spouse
  • A young adult that is married or has coverage available elsewhere making them ineligible for your sponsored coverage

While this may seem more like a data maintenance issue at first, covering ineligible dependents costs you in unnecessary premium costs and claims exposure. This may also lead to reporting improper data to the IRS for purposes of the ACA (IRS Form 6056).

Benetech's Eligibility Review Program:

  • Reduces costs by removing ineligible dependents from your plans;
  • Mitigates your fiduciary exposure and liability through a methodical verification and documentation process; and
  • Increases the accuracy of your reporting to the IRS for the purposes of the ACA.

Pre-Payment Claims Review

If you are self-insured and funding your own claims we can ensure the accuracy of your claims payments with our Pre-Payment Claims Review solution. Our service validates your weekly claim file against eligibility (enrollment data) to approve each claim before any payments are made.

Implementing this process on an ongoing basis is both a corrective and preventive measure and helps to avoid miscellaneous expenditures.

Some of the features include:

  • Edit report indicating the potential ineligible claims selected for review
  • Outcome report detailing the review of the potential ineligible claim and the final disposition of claims
  • Savings report which tracks the actual dollars saved by preventing an ineligible claim from being paid
  • Reports are generated each claims payment cycle and can be generated on a cumulative basis

Customer Service Center

Is your HR staff overwhelmed with calls regarding eligibility, claims issues, billing questions? Let our Customer Service Center relieve you of the burden of dealing with these calls and interfacing with the carriers.

Our experienced customer service team can handle your inquiries and handle carriers on your behalf. Our phone system provides user statistics including volume of calls and abandoned call rate.

Our proprietary call tracking and reporting system (generated weekly for review by Account Management), coupled with supervisory oversight of our customer service staff, prevents problems or issues from slipping through the cracks. This direct line of contact approach yields superior results in terms of providing quick and responsive resolution to problems and issues that arise.

In addition, we have an online self-service support for those members who would prefer to make inquiries online.


Consistent communications are key to the success of any initiative. Benetech works in a collaborative effort with its clients to clearly and concisely communicate the details of their respective initiatives, such as:

  • Plan Documents and Summary Plan Descriptions
  • Comprehensive Employee Benefit Statements
  • New Plan Offerings/Benefit Changes
  • New Laws/Regulations
  • Open Enrollment
  • Draft and distribute notices and educational materials
  • New plan offerings
  • Benefit changes
  • Coordinate and facilitate group presentations
  • Open enrollment
  • Q & A sessions

Eligibility Management | Common Billing Remittance | Integrated Dependent Eligibility Verification | Pre-Payment Claims Review | Customer Service Center | Communications

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