Benefits Consulting

Sibson Consulting offers a full range of consulting services for health plan sponsors, including:

• Health Plan Design Sibson Consulting's health consultants have extensive experience in the design and redesign of all health benefit plans for employees and retirees, such as medical, dental, prescription drug, vision, behavioral health, short- and long-term disability, life, accidental death and dismemberment and flexible benefits.
• Vendor Selection Sibson Consulting creates custom requests for proposals (RFPs) for fully insured and/or self-funded plans. We create and analyze vendor/bidder responses from the full array of managed care organizations (MCOs): health maintenance organizations (HMOs), preferred provider organization (PPOs) and point-of-service (POS) plans. Our analysis covers vendors' fee projections. Sibson Consulting also negotiates with vendors and helps clients coordinate vendor management.
• Projection and Forecasting of Benefit Plan Costs Sibson Consulting's consulting services include projecting claims, setting contribution and COBRA rates, determining reserve requirements, performing incurred-but-not-reported (IBNR) calculations required for retiree health accounting, analyzing the impact of proposed plan design changes, underwriting and funding methodology, creating budget and renewal projections, preparing annual health benefits reports, determining pricing for flexible benefits, conducting merger studies and analyzing the development of health care purchasing coalitions.
• Evaluation and Formulation of Provider Reimbursement Methodology Evaluation and formulation of provider reimbursement methodology includes per diems, diagnostic-related groups (DRGs), outliers, discounts, capitation and physician services and procedures.
• Health Care Quality Assessment (Q-Val^SM) For more information on this unique service, click here.
• Collection and Analysis of Cost Utilization Data Collection and analysis of cost utilization data includes monthly claim experience, health care trends and cost savings.
• Medical Claims Auditing Sibson Consulting's claims auditors review medical, dental and/or prescription drug plans for fully insured and self-funded administrative-service-only claims administrators to assure financial and procedural accuracy in claims processing. We can benchmark results for clients to industry norms.
• Reviews of Pharmacy Benefit Managers (PBMs) Rapidly rising prescription drug costs are driving overall increases in the cost of health coverage. Sibson Consulting's health consultants conduct PBM reviews that yield information that can be used to manage the cost of prescription drug coverage.
• Design and Implementation of Prevention and Medical Management Features Sibson Consulting designs and implements health promotion/wellness programs, employee assistance programs (EAPs), managed disability programs, disease management programs, centers of excellence programs, 24-hour, telephone-based nurse "triage" programs, executive physical exam benefits and long-term care coverage.
• Health Compliance Updates and Research Sibson Consulting keeps clients informed about health compliance news through publications, including the Web-based Capital Checkup, a periodic electronic newsletter summarizing activity in Washington with respect to health care and related subjects. Sibson Consulting's health compliance consultants can be retained to research plan sponsors' specific questions about compliance issues, update or create plan documents, create amendments and investigate vendor compliance with state and federal laws (e.g., ERISA, HIPAA and COBRA).
• Participant Communications Sibson Consulting's communications consultants write and design general or personalized participant communications, including summary plan descriptions (SPD), participant communications required by state and federal laws, announcements about plan amendments, brochures highlighting plan features. In addition, Sibson Consulting publishes Health Report, a quarterly subscription newsletter for plan participants that is devoted to wellness and promotion of a healthy lifestyle.
• Design and Tabulation of Participant Surveys Participant satisfaction with their benefits contributes to a content workforce, and content workers are less likely to seek alternative employment. Sibson Consulting can draft, conduct and tabulate custom surveys to assess participant satisfaction annually or periodically. Our communications consultants can draft and design summaries of survey results for distribution to participants.
• VEBA Consulting A voluntary employees’ beneficiary association (VEBA) is one option for organizations that are looking for a new way to handle the rising costs and obligations of retiree health benefits, especially when these benefits are collectively bargained or the company is in bankruptcy. Our consultants can help with many aspects of setting up and managing a VEBA.
• Healthy Enterprise Initiative In order to maximize the efforts of engaged employees (those who know what to do and want to do it), organizations need to develop a strategy to minimize the impact of health, personal (e.g., legal, financial, family, dependent care, elder care) and work (lack of tools, resources or support) issues. To help with this, Sibson has developed an approach to creating a Healthy Enterprise.

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