The “Must-Do’s” of Group Health Insurance Administration 

Your organization has reached a significant milestone by implementing a group health insurance program, a strategic move aimed at not only attracting but also retaining top-tier talent. You’ve navigated the complexities of the quoting process, meticulously selected Benefits, and successfully conducted open enrollments. The Benefits are now in effect, and it might be tempting to ease off the gas pedal, thinking you can coast until the next hire or occasional life event prompts insurance adjustments. However, this mindset could lead to a critical oversight. In fact, ongoing Benefits administration is every bit as vital, if not more so, than the initial enrollment phase.  

This blog will review five essential actions that every group Benefits administrator should take. These actions are necessary to ensure that the organization remains compliant with various regulations, avoids financial losses, and keeps employees well-informed and engaged regarding their Benefits at all levels.  

Monthly Reviews of Eligibility for Group Health Insurance

One crucial task any Benefits administrator must do is conduct a monthly review of all system information, as a minimum requirement. One major reason for this is that there are times when insurance carriers will not accept changes that need to be retro’d (or backdated) more than 60-90 days. For example, it is a great best practice to have a checklist of sorts that covers various aspects, including but not limited to: 

• Gain of eligibility for employees based on work or life events.  
• Loss of eligibility for employees/dependents based on work or life events. 
• Ensuring that all pertinent information relating to Benefits is accurately recorded for not only employees but also dependents/beneficiaries (information like SSN, DOB, address, relationship, beneficiary primary and contingent percentage splits, etc.).  
• Verifying that any terminated employees do not retain active Benefit plans unless they have enrolled in COBRA (if your organization is eligible for this option).   

Reconciliation of Premium Invoices 

Group health insurance is ever-changing, even after the Benefits effective date. For example, a small business onboards new hires, terminates employees, accommodates employees who have qualifying life/work events, etc. Reconciliation of premium invoices aims to confirm that all invoice charges are correct. Let’s face it, Benefits are expensive, and you do not want to pay a cent more than what you are responsible for paying.  

Other than ensuring that the charges are correct, invoice reconciliation should also review the following areas of Benefits:  

• Effective dates 
• Information accuracy (employee and dependent DOB, SSN, etc.) 
• Dependent enrollments  
• Ensuring anticipated credits are issued for employees/dependents. 

Mercer conducted a study that showed the average turnover rate in small businesses in 2022 was 24.7 percent. Ensuring these employees are removed from your invoicing can yield substantial savings for your organization. Ignoring Benefits invoicing will result in overlooked funds for your organization.  

Employee Education of Group Health Insurance

Most employees do not know the finer details of their group health insurance. Let’s face it, most employees do not even look at the summary of coverage when enrolling in their Benefits! Benefits administrators have a shared responsibility to continually educate their employees on their Benefits. Below are areas of group health insurance that frequently need additional educational opportunities for your employees:  

• Complex Benefits Jargon – helping simplify the terminology used in employee Benefits can help employees make more educated and informed decisions about their health insurance. Helping your employees understand how different parts of their Benefits work together is crucial (deduction, out-of-pocket maximums, co-insurance).  
• Carrier Technology Access – most carriers have a mobile app or website in which their digital cards, plan summaries, finding in-network providers, YTD claims, etc. are all available to the employee at the click of a button. By educating your employees on how to access this technology, you can save Benefit administrators time and energy, eliminating the need for repeated responses and empowering employees to find the information they need independently.   

Educating employees about their Benefits offers numerous advantages, including:  

• Higher employee retention 
• Increased satisfaction with Benefits 
• Greater engagement levels 
• More positive work culture 

Compliance Awareness  

There is a TON of acronyms used in group health insurance, compliance, and regulatory agencies. Some of the most common areas of compliance that group health Benefits administrators need to be aware of and educated on are:  

• ERISA (Employee Retirement Income Security Act of 1974) 
• ACA (Affordable Care Act) 

• COBRA (Consolidated Omnibus Benefits Reconciliation Act) 
• Mini-COBRA (State Continuation of Benefits) 
• SECTION 125 (Section 125 of the IRS Tax Code that states the requirements needed to offer pre-tax Benefits) 
• Plus, many others (trust me!) 

I won’t delve into the specific details of each compliance measure here, as that would turn this blog into a novel. However, it’s essential for Benefits administrators to determine which rules apply based on their group’s size and to be aware of the reporting obligations associated with each compliance and regulatory requirement. Failure to meet these requirements can result in astronomical fines, making compliance a critical aspect of managing group health insurance effectively.  

Always Look for Efficiencies  

If your organization does not take advantage of an enrollment system for your Benefits, you might as well be playing Oregon Trail and downloading your internet off of a CD-ROM (if you get my references, you’re in my age bracket)! Embracing and leveraging technology can simplify both your life and your employee’s lives.  

Below are the advantages of utilizing a Benefits enrollment system for your organization to aid with efficiencies:  

• Electronic Enrollment  
• Streamlines data entry, reducing errors on handwritten forms. 
• Centralizes Benefit information, serving as a resource for employees. 
• Automates processes triggered by life/work events (new hires or changes in employment classification) 
• Reporting 
• Reports that can be generated to help with renewal quoting (census information), Benefit statements, enrollment reports, etc.  
• Generates various reports for purposes such as renewal quoting (census data), Benefit statements, and enrollment reports. 
• Reconciliation 
• Offers built-in tools for reviewing premium invoices, aiding in financial accuracy.  
• Integration with Carriers 
• Many Benefit systems can integrate with carriers to allow automatic delivery of Benefit changes to the carrier site. This helps alleviate the chance of missing certain changes or entering the change incorrectly on the carrier site.  

Seems Like a Lot? 

It is, and we’ve barely even scratched the surface! You’re not alone in feeling overwhelmed by the complex world of group health insurance. That’s where Whirks come in and we’re here to make your life easier. Imagine having a trusted partner who not only simplifies but excels at benefits administration. That’s what you get with the Whirks Benefits Services – your all-in-one solution to navigate the intricate maze of benefits administration effortlessly.  

Let’s break it down:  

• Agent of Record – We’re your insurance whisperer, identifying and delivering the best group health insurance options tailored to your organization's unique needs.  

• Carrier Invoice Reconciliation – No more headaches from juggling invoices. We reconcile every carrier, every month, ensuring nothing slips through the cracks.  

• Full-Service Open Enrollment and Administration – We take the reins on project management and implementation of our Open Enrollment software for not only annual renewals but also for any life/work events that your employees may experience!  

• Compliance – A to Z compliance for your organization (COBRA, ACA, ERISA, etc.) 

• Employee Hotline – Have questions? Your employees can turn to us directly. We provide individualized support for any Benefit-related inquiries, making their lives easier too.  

Don’t want to navigate this challenging terrain alone? Let Whirks be your guide. Schedule a call with us today. Or if you just want to learn more about group health insurance, check out this article to help you know what to expect when getting a quote for group health insurance.