employs a staff of individuals dedicated to helping your Health Plan maintain compliance with applicable laws and regulations, including the new HIPAA, HITECH and PPACA regulations. Our Compliance Department is continually monitors new legislation, Dept. of Labor, IRS and CMS regulations and bulletins, and court decisions, which may impact the administration of your Company Health Plan. Because our Compliance Department is in-house with access to all other departments, we can work with you to ensure any necessary adjustments to Health Plan administration are efficiently and seamlessly integrated.
- Summary Plan Documents
- Summary of Benefits and Coverage
- Value of HealthCare Coverage
- 5500 Forms
Summary Plan Documents
HealthComp is prepared to consult and assist you in the preparation of your Company Health Plan Document by utilizing specially designed software that supports its preparation. This software contains legal language that is continually being updated by a panel of ERISA attorneys.
From time-to-time, you may wish to modify your Plan Document for benefit or eligibility changes. There may also be times when your Plan Document needs to be amended for legislative changes. HealthComp
is prepared to assist you in the preparation of the necessary amendments, as well as the preparation of the appropriate communication to your employees, such as booklet inserts.
Summary Benefits and Coverage
Health Care Reform requires Health Plans to provide the Summaries of Benefits and Coverage (SBCs). HealthComp
is able to assist our clients with the preparation of the SBC for their Plan. SBCs must be distributed during open enrollment. It must also be provided upon request by any participant, and upon of any material Plan changes being made to the SPD.
Value of HealthCare Coverage
All employers are required to indicate on their employees’ Forms W-2 the Value of HealthCare Coverage they received through their employment during the year. The Value of HealthCare Coverage is defined as the total cost of the coverage contributed by both the employer and the employee. At HealthComp
, we track the total enrollment for each specific type of coverage and for each employee. Upon request, HealthComp
provides a detailed report of the Value of HealthCare Coverage. The report includes the employee’s identification number, and the number of months the employee was enrolled on each type and level of coverage. Alternatively, the data can be reported in a custom format suitable to your payroll service’s specifications.
is prepared to complete and file the required legal filings, such as the annual 5500 Form and schedules. We request, gather and compile the necessary information to complete the 5500 Form, such as claims data, insurance premiums, commissions and other vendor payments.
repeatedly analyzes accuracy levels. During the first 60 days following each client's implementation, our Quality Assurance staff processes all claims to assure proper programming and training has been completed. Ongoing audits are performed utilizing a system-generated random sample examining five percent of all claims paid. All high-dollar claims (more than $5,000) are audited and approved before being released for payment.
dedicates experienced full-time personnel to protect both the Plan’s right to subrogation and the Plan's priority right of recovery. Our claims examiners review all claim submissions for potential subrogation or third-party liability.
Our staff utilizes several indicators to identify potential subrogation or third-party liability. If any of these indicators are present, the examiner presents the claim(s) to the Subrogation Department for further processing. The Subrogation Department then sends a lien notice to all related parties such as the employee, attorneys and all associated insurance companies.
is prepared to assist in the pursuit of potential recoveries, utilizing both internal and external legal professionals during this process.