Thursday, August 16, 2012

BOYD Consultants Save the District Money by Recommending a New Third Party Administrator

By:  Tonya Williams, Employee Relations Specialist
School District of Janesville

During the week of August 20, District staff will receive new health insurance cards arriving at their home addresses.  Boyd Consulting Group, Inc. (BCG), our insurance consulting firm, has been working with the School District of Janesville in evaluating its health insurance plan.  This summer BCG requested formal proposals from other third party administrators (TPAs) because our current third party administrator, UMR, had a 21 percent increase in total cost that included administrative fees and stop-loss reinsurance premiums.

For those of you new to the “language” of health care, a third party administrator is a firm hired by an employer to handle claims processing, pay providers, and manage other functions related to the operation of health insurance.  The TPA, however, is not the policyholder or the insurer.  Stop-loss is also known as reinsurance.  Stop-loss reinsurance is used by self-insured employers and limits the amount the employer will have to pay for each person’s healthcare (individual limit) or for the total expenses of the employer (group limit).  For example, if a person’s health care expenses exceed $375,000 our stop-loss carrier will then reimburse the District.

After an extensive review of the proposals received, BCG recommended that the District move our TPA services to Professional Benefit Administrators (PBA), move our stop-loss reinsurance to Zurich Life Insurance, and increase the stop-loss deductible to $375,000.  These simple changes will not affect the coverage that our staff currently receives, and it will benefit the District in the amount of $438,193. 

Effective September 1, 2012, staff will need to use the new health insurance cards when going to a medical provider or picking up a prescription.  Your dental cards will remain the same.  You will continue to contact Coordinated Healthcare (CHC) at 1-877-550-3455 for questions or concerns relating to your health care claims as well as finding a network provider.  Please keep in mind that Coordinated Healthcare can assist you in many different services, and you should always contact them first. 


If you have any questions, concerns, or feedback relating to these changes, please contact Tonya Williams at 743-5021.

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