High high expectations of your benefits broker

MANAGEMENT

EMPLOYEE BENEFITS

As an employer, your credit union knows that providing health insurance protection for employees is a serious responsibility. As a key component of your benefits package, group health insurance ensures employee security and enhances job satisfaction.

But in a health-care system that's become more complex, benefits sometimes turn into nightmares for employees. Case in point: Mary, president of a credit union in the upper Midwest, was denied several health claims totaling nearly $3,000. She appealed to her state insurance commissioner but got no satisfaction. Only after several months of disputes with her insurance carrier-- and a helping hand from CUNA Mutual's employee benefits service center-was Mary able to get the carrier to pay according to their contract agreement.

Mary's experience isn't unique. It merely demonstrates the importance of finding a health insurance broker, or agent, with the necessary experience in claims processing, administration, billing, case management, and customer service that will guarantee your employees a benefit that works for, not against them. The Health Insurance Association of America (HIAA) recommends looking for a broker with special professional qualifications and many years of experience.

HIAA says a first-rate broker or agent will:

* Provide advice on the right insurance policy to fit your special needs. The broker should ask enough questions to learn about your entire insurance picture before advising you.

* Explain the cost and coverage of a policy you are considering.

* Keep you informed about new insurance plans.

* Review your insurance with you every year to consider changes in employees' financial or family status that might change your insurance requirements.

* Help you handle claims, answer questions, and resolve any insurance problems. HIAA says brokers should answer these key questions about employee health coverage:

* Are there medical service limits, exclusions, or pre-existing conditions?

* Are there procedures like utilization review, precertification, and second surgical opinion?

* What's the total cost of the policy for the employer and for employees?

* Is the rate guaranteed? For how long?

* What's the policy's lifetime maximum amount of coverage?

* What's the rate history for comparable groups over the past five years and how's it calculated?

* What will happen to premiums if an employee has a major claim?

* How will service needs be handled?

* Will the broker or a representative meet with employees and dependents?

* How long will it take to process a claim?

* How often will the employer be billed?

* Does the broker know about small-group insurance?

These and other issues are critical to obtaining a plan that serves employees' needs most effectively. They're questions best answered by seasoned professionals. If a claim is denied or delayed and you believe it should be investigated, a good broker will contact the carrier on your behalf for an explanation, then follow up and provide suggestions for further action, if necessary.

Expect your broker to provide administrative assistance as well. When plan administration becomes complex, your broker should provide the credit union's administrator with the information and materials necessary to make the job easier.

In short, finding the right broker is just as important as finding the right insurance plan. Your broker is a consulting partner responsible for developing a strategy that foresees changes in the marketplace, anticipates future needs, and advocates on behalf of your credit union.*

Contact your local CUNA Mutual Group division office at 800-333-2644, visit www.cuna mutual.com, or e-mail the author at sherry. olson@cunamutual.com.

SHERRY OLSON is employee benefits service center managerfor CUNA Mutual Group, Madison, Wis.

Copyright Credit Union National Association, Inc. Mar 2001
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