Group Benefits Design and Administration

Lesson 1: Introduction to Group Benefits Programs

1. Group Benefits Defined
2. Differences Between Insured and Noninsured Benefits
3. Benefits Provided on a Noninsured vs. Insured Basis
4. Sick Leave Benefits
5. Salary Continuance Benefits
6. Wellness Programs
7. Dependent Care
8. Health Care Spending Account (HCSA)
9. Plan Sponsor's Role in Group Benefits Program Management
10. Interrelated Factors that Impact Benefits Plan Management
11. Plan Design, Administration and Funding
12. Factors That Affect Plan Objectives
13. Complexity of the Plan Sponsor’s Program Management Role and Responsibilities

Total pages in lesson: 13

Lesson 2: Group Benefits Program Design

1. Benefits Program Design Process
2. Benefits Plan Philosophy/Benefits Objectives Statement
3. Different Classes of Benefits
4. Functional Approach to Benefits Program Design
5. Key Steps in the Functional Approach
6. Advantages of the Functional Approach
7. Life-Cycle Approach to Benefits Program Design
8. Financing Considerations—Noncontributory vs. Contributory
9. Financing Considerations—Direct vs. Indirect Cost Sharing
10. Financing Considerations—Taxation

Total pages in lesson: 10

Lesson 3: Approaches to Group Benefits Program Design

1. Broad Approaches to Group Benefits Program Design
2. Traditional With Add-ons Benefits Approach
3. Reasons for Using a Flexible Approach
4. Modular Flex Approach
5. Full Flex Approach
6. Total Rewards Flex Approach
7. Benefits Suitable for Inclusion in a Flexible Design Approach

Total pages in lesson: 7

Lesson 4: Group Benefits Program Administration

1. Common Administrative Approaches
2. Basic Responsibilities in Benefits Plan Administration
3. Enrollment and Eligibility Administration
4. Confirmation of Eligibility
5. Evidence of Insurability
6. Managing Coverage Provisions
7. Insurer Administration
8. Self-Administration by the Plan Sponsor
9. Administration by a Third-Party Administrator (TPA)
10. TPA’s Relationship with an Insurer

Total pages in lesson: 10

Lesson 5: Key Requirements of Group Benefits Program Administration

1. Overview of Claims Administration
2. Role of Claims Adjudicator
3. Time Limitations for Submitting Claims
4. Electronic Claims Submission
5. Premium Administration: Self-Administered Plan
6. Premium Administration: TPA-Administered Plan
7. Premium Administration: Insurer-Administered Plan
8. Benefits of Automated Systems for Premium Administration
9. Recordkeeping Administration
10. Timely Reporting of Employee Terminations
11. Reviewing Plan Experience Results
12. Communication Administration
13. Communication Strategy
14. Information to Include in the Communication
15. Most Common Problem With Benefits Communication

Total pages in lesson: 15