Here are four key questions that a benefit advisor should ask to ensure that their employer group clients are practicing

Demand access to the group's claims: The Consolidated Appropriations Act of 2021 prohibits gag clause mandates, so employers have a right to their claims data. Advisors must ask, "Are claims being reviewed annually to understand the group's trendline compared to benchmarking standards?"
Help employers understand what they're paying for: Advisors should review the tools being offered to employees to leverage and whether reasonable fees are associated with them. Advisors must ask, "Is there verification of an annual review process ensuring Plan fees and associated services were rendered to the Plan per outlined service agreements at a reasonable cost for the sole benefit of the plan and its participants?"
Personally test the tools made available to employees: If an advisor suggests a platform or tool, make sure to test it so that it works as promised. Advisors must ask, "Is there a defined process for evaluating provider services, i.e., direct primary care, direct contracting for specialty, on-site services or virtual telemedicine, etc.?"
Test yourself: This may be the hardest takeaway, but it will likely be the most appreciated by employer groups and will highlight the character of an ethical benefit advisor. It must be asked: "Within the past 3 to 5 years, has there been a formal RFP process performed regarding the fees and services of your benefit advisor?"

These four questions will distinguish the advisors who have embraced these changes from those who prefer the status quo. By taking decisive action and supporting employer groups in their pursuit of prudent fiduciary actions, benefits advisors can help reshape the health care ecosystem and ensure cost-effective, high-value care for all employers and employees.

Instant Insights /

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