Q. What is ASO?

A. Administration Services Only is a funding method for your health and dental claims. Rather than traditional premium plans, you pay only for the claims submitted, approved and paid, plus an administration fee typically a percentage of claims paid.

This method of claims payment significantly reduces the cost of a benefit plan. 

Q. How does an ASO plan differ from a traditional  plan?

A. The most dramatic difference is the "un-bundling" of a typical benefit plan. An ASO plan separates the insurance component from the claims component. Insurance is placed with a competitive carrier while health and dental claims go directly to the adjudicator.

In traditional plans a carrier acts as a retail distributor for health and dental claims. In an ASO plan your health and dental claims are adjudicated at wholesale level.

Q. What is a TPA?

A. A Third Party Administrator;
a) consolidates billing for ASO policies
b) consolidates the enrolment process
c) provides multi-carrier opportunities not available in traditional plans
d) provides detailed reporting of claims for management
e) provides simplified administration and administration support
f) Eliminates re-enrolment of employee census data should a carrier be replaced
g) offers unlimited combinations of plan design to achieve an employer's objectives and budget goals

Q. How much does a TPA cost? 

A. Typically a TPA will charge anywhere from 3% to 6% of claims (based on volume) either on a submitted claims basis or a paid claims basis. Group Benefits Unlimited is a TPA with our own proprietory TPA systems. 

A quote from Group Benefits Unlimited, or from one of our partner advisors include TPA services. Check out our "Illustrator" to demonstrate the effectiveness of our ASO program and the competitive nature of our quotes including TPA services.

Q. How will we benefit by using a TPA?

A. Just Imagine;

• no health and no dental claims were processed this month
• $0.00 is due for health & dental claims payment this month
• $0.00 is due for health & dental administration this month
  
•  The benefits do not stop with Cost Control
  •  A completely transparent billing system 
  •  Make decisions based on  your own company data. 
  •  No more renewals!
  •  HR support, services and systems
  •  Employee B2E Reports
  •  T4 Taxable benefit reports
  •  Efficient
  •  Simple 

Q. Should we use Stop Loss or cap our benefit plan? 

A. A stop-loss insurance policy eliminates an employers liability for catastrophic losses due to health claims. This allows employers to pay for routine predictable claims but places liability for large unforeseen claims onto an insurer.

A capped program places restrictions on the total dollar amount of claims that will be paid per employee per annum.

Employers have used both strategies successfully. The capping method is more restrictive. Alternative government programs are available to employees whose needs are greater than an employer can sustain.

Q. What is required if an Employee decides not to participate in a group plan?

A. Ensure that all employees who elect not to participate in the benefits plan sign a waiver of participation form.  Most insurance carriers have very rigid requirements surrounding employee and dependent(s) eligibility. An application for enrolment received later than 31 days after the probationary period has been satisfied may be subject to medical underwriting, pre-existing condition restrictions, limitations of coverage or total decline. Ensure enrolment procedures are in place. Any delay in the submission of these forms a "Late Applicant" situation is created, which requires a higher level of underwriting and a higher level of disclosure for the plan member.

For Health and Dental benefits your administrator can set the date for enrolment. Changes to your plan simply require authorization.

Remember that in an ASO plan, insurance benefits are separate from health and dental benefits. Company policy may dictate that participation is mandatory. If this is not the case a review of your Group Insurance contract may dictate the rate of participation for the whole group. It may be 100% or 75% of all employees. Generally employees who have duplicate coverage under a spouse's plan may waive health and dental benefits. A certain amount of caution is advised here. Employees may believe that the benefits are too costly now but when circumstances change may believe that an employer did not clearly explain the benefits of participation.

Q. If a claim is covered by WSIB do we still have to submit an LTD claim ?

A.  It is recommended that in the event of a WSIB claim, the plan member should apply for the long term disability (LTD) benefit. By applying, the LTD benefit could be available if WSIB terminates benefits and an employee may be eligible for waiver of premium on life insurance and long term disability coverage.

Q. What if someone is on the plan that should not be?

A.  For life and disability insurance coverage most benefit plans have an “actively-at-work” requirement as well as a minimum hours worked requirement with the exception of retired employee coverage.  Consider requesting an amendment to add a new class of employees with altered eligibility rules.

 For health and dental ASO plans, you definitely have the flexibility to add people that are not employees. However, you must consider the impact of increased claims against your overall plan cost and the possibility that your plan could lose it's tax status with CRA.