Using proprietary actuarial cost models, we estimate the cost and volatility of the health plan expenses to determine if self-insurance is feasible.  We complete a pricing calculation to establish a projected premium rate and then calculate actuarial cost factors for age, gender, area, plan design, and coverage tier to discover the areas of greatest risk.  Finally, we include a stop-loss analysis to choose appropriate levels of stop-loss coverage.

 

Using our actuary’s extensive M&A experience, we’ve put together a package of exhibits and analyses to help you determine the effect of the M&A on your plan, specifically geared to support due diligence.  We provide a side-by-side assessment for plan design, premium, type of funding, vendors, employee contributions and stop-loss coverage, as well as a forecast of potential scenarios.  Included as support are actuarial models for demographic analysis, pricing and plan design changes.

 

PBM Evaluation – Pharmacy Benefit Manager Evaluation: 

Similar to the medical discount analysis, our Pharmacy Benefit Manager (PBM) Evaluation compares the cost of prescriptions under various PBM discounts.  In addition, we take the analysis much deeper to understand variations with rebates and formulary utilization to help you understand the complexities of PBMs.

 

Discount Analysis compares the network discounts under various provider networks based on an employer’s unique characteristics.  Using the employer’s census and claims experience as well as our utilization models, we evaluate the carrier’s responses.  Depending on the timeframe and data availability, we can complete a full re-pricing or more limited comparisons. 

 

The Benefits Positioning System helps each employer “position” their benefit plans relative to others in the nation, their specific industry, and their area.  Using the data from the Mid-Market Benefits Survey processed through our cost and utilization models, we develop a relative value score for each employer.

 

In conjunction with pension actuaries, we can complete FASB 106 or GASB 43/45 valuations for retiree medical plans.  In addition to the valuation , our consultants can help assess the impact of plan design changes and suggest alternatives.

FASB 112 Reserve Calculation: 

For employers with self-insured disability plans or for the reserve transfer during a change in disability carriers, our Health & Welfare actuaries can calculate the FASB 112 valuation.  We are also able to consult on ways to reduce this liability.