Case Studies
Global Approach:
A Client-Perspective Case Study
"We were dealing with spiraling health care costs that exceeded our budget. We had a long-term relationship with a local broker, whose office was less than a block away from our office. However, as a result of our healthcare costs, we accepted competitive proposals from other brokers for the approaching renewal. At that time, we were looking at a 23% increase from our incumbent relationship on the medical and dental policy alone.
Apex was able to deliver an advantageous proposal by maintaining the quality of our medical and dental benefits packages, improving the life insurance benefit, and adding a vision plan and a flexible spending account which we previously did not offer, while simultaneously decreasing costs by $1.2 million, or 21%, from the present year.
The renewal Apex negotiated was not a one time fix. The subsequent years our renewal increases were 3.35% and 3.42%. Our actual annual claims costs for declined as a result of better network utilization and plan design. We are continuing to realize the benefits of the program Apex implemented three years ago.
Apex was able to create a quality package while providing savings based on the network analysis they conducted, large claims research, underwriting preparations, and taking time to understand what we want to provide to our employees. With Apex's guidance, we were able to make an informed decision and target changes that are still working for us today and will continue in to the future."
Financial Perspective:
A Client-Perspective Case Study
We asked John Gause to review our medical plan claims report as we had questions regarding the information provided by our TPA. In the course of this review, John discovered an aggregate claim reimbursement from the previous plan year that had not been paid to us. This over due reimbursement was in excess of $90,000, which our current agent and third party administrator had not reported. Subsequently, we approached our TPA to request this reimbursement from our reinsurer on our behalf.
Also, we had a partially self funded plan and a separate HMO plan . We were experiencing significant PPO problems as well as service issues with our administrator. Apex was able to provide a financially competitive solution to bring the plans together under one administrator and one national network. Apex was able to move us to a dual option PPO plan which benefited our employees and the implementation of the new carrier and PPO provided deeper network discounts and easier administration that directly impact our bottom line."
Employee Focus: A Case Study
A central Indiana employer with 100 employees, filed a disability claim on behalf of one of their members. Unfortunately, at the onset of the claim, the company's disability insurance was through one company and the company's life insurance was through another, so there was no automatic filing of a waiver of premium claim with the life insurance plan. Subsequent to the onset of the disability the life insurance carrier changed. Nearly a year and half later, the disabled employee died and it was discovered that the waiver of premium claim had not been filed. As a result, his family learned that no life insurance benefits would be due to them and they set about making financial arrangements for the final expenses out of their own pocket.
The Account Manager with Apex solicited information from both the in force life insurance carrier and the prior life insurance carrier, and appealed to the prior life insurance carrier to review a posthumous waiver of premium claim based in part on the disability claim filed and approved through another insurance carrier.
Nearly a year after the employee's death, the employee was determined to have been disabled under the prior life insurance plan, qualifying for a waiver of premium, and as such the family was able to file a life insurance claim for the full benefit due, $20,000."
"I
appreciate knowing an associate will answer when I call Apex and even
if Toni is not available, they will give me someone who is able to
offer assistance. Although Apex's office is in Indianapolis, they have
been as accessible as any local agency we have ever had."
Elaine Mortara,
Ripley County Deputy Auditor,
Versailles, Indiana
