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Detailed Claims Reporting – Example

Analyzes the overall drug uses for your employees and categorizes them into “Disease States” or “Therapeutic Classes” to help identify the health states of your employees and their families.

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Detailed Claims Reporting – Example

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  1. Analyzes the overall drug uses for your employees and categorizes them into “Disease States” or “Therapeutic Classes” to help identify the health states of your employees and their families. Based on the findings, recommendations are made on how best to utilize MY WELLNESS to assist in reducing claims usage over the long-term. Detailed Claims Reporting – Example Drug Utilization Review (DUR) Drug Utilization Reviews (DUR’s)”:

  2. Claims Incurred by Plan Members Employee Wellness What tools can be deployed to improve employee wellness (both physical and mental) ? • Research shows that there are 2 key factors that make a successful wellness program: • Tools/programs that are confidential • Tools/programs that have a systematic support mechanism • Areas of importance for physical wellness: smoking cessation, alcohol and drug abuse, nutrition, weight management and stress management. • Areas of importance for mental wellness: family relationships, work environment and relationships, elderly care, childcare, alcohol and drug abuse, stress management, etc.

  3. MY WELLNESS Get Well. Stay Well. Live Well. • HealthSource Plus a People Corporation company is a leader in providing Wellness initiatives to our Employers. By combining flexible administrative services with best-of-class service providers, our wellness programs are a powerful ally in reducing long term health costs • MY WELLNESS includes: • Wellness Specialist • Needs & Interest Survey • Health Risk Assessments (3 types) • “Ask the Expert” - 24/7 Nutritional • Counseling On-line • And much, much, more!

  4. MY WELLNESS Get Well. Stay Well. Live Well. Online Programs for staff and families

  5. MY WELLNESS Get Well. Stay Well. Live Well. Bilingual Monthly Wellness Newsletter: Included

  6. Claims Incurred by Plan Members Employee Communication & Education Employee communication & education strategies can have a positive impact on long-term claims management if they: • Engage the employee. • Educate employees on how their claiming behaviours affect the cost of the program. • Encourage and guide employees to become conscious consumers. • Provide tools to employees that promote employee self service as employee self service engages employees. • Provide employees with tools to assist them in understanding what they are covered for. • Conduct employee benefits surveys to uncover the needs & attitudes of employees.

  7. Our Concierge Service Program Client Service that is second to NONE! • Written Concierge Service Guarantee (meet at 4, 8, and 12 months) • Dedicated Senior Benefits Consultant • Dedicated Account Executive • Dedicated Customer Service Specialist • Dedicated 800 number for employees and for Plan Sponsors • Exclusive Online Services including; • eProfile™ – our only benefits portal for employees, their spouses and dependents • All forms online, Direct Deposit claims payment • eClaims - online claims submission • Customized Employee Communications

  8. Thank You for your Time Today Rob Carducci, REBC, GBAPartner/Senior Benefits Consultant2225 Sheppard Avenue EastAtrium III, 14th FloorToronto, Ontario M2J 5C2Phone: (416) 445-0000/Toll Free @ 1-800-753-0110 ext. 229Fax: 1-866-398-1229Cell: (416) 302-0413E-mail: rcarducci@healthsourceplus.comWebsite: www.healthsourceplus.com

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