Corporate Employee Benefits
Med-Sure has been providing strategic and administration support for companies managing their own employee benefits programmes for over 20 years. We offer “full service” employee benefits management services for self-funded employers.
We are not an organization that just processes and pays medical claims, and we are not involved with companies seeking a low cost fix.
We are sourcing companies that have an holistic approach to managing their employee benefits, ensuring that the available financial resources are used sensibly, enhancing employee benefits and the overall welfare of both the employee and the company. Our service includes:
- Employee benefits design and implementation
- 24/7 Emergency Hotline
- Cost containment advice and strategies
- Access to our network of more than 215 hospitals and clinics throughout Thailand
- Stop Loss insurance monitoring and management
- Full banking and accounting administration and management reports – transparent reporting
- Provision of Employee Benefit Plan documentation including membership handbook and ID Medical Cards
- Case management in the case of serious or long-term illness
- Dependent eligibility audits
- Inappropriate use of the plan benefits
Employee Benefits Design and Implementation
When it comes to employee benefits, plan design is an on-going process that helps your health plan respond to the ever-changing needs of your organization and changes in the competitive and legislative environment. However, deciding which benefits to offer and agreeing levels of remuneration can prove to be a challenge in isolation. We can assist in the provision of benchmark data for your industry and location to help you make informed choices.
Managing your employee benefits plan includes claims administration, help with regulatory compliance, education and the need to provide constant information to employers, divisional managers, unit managers, departmental manager and employees.
Left unchecked, claims processing is relegated to a mere transactional function. At Med-Sure we focus on providing a professional health plan administration service that requires a high level expertise, attention to detail and a focus on customer satisfaction. The key highlights include:
- Our employee benefits software has been developed in-house, is flexible and can be adapted to meet the specific needs of most companies
- Trained benefit analysts along with medical professionals handle all aspects of customer service related to claims, including answering your questions or questions from your employees. This means most enquiries are resolved upon the first call.
- We try to eliminate the assembly-line atmosphere, so common to other claim processing operations, by assigning analysts to work in small teams specifically dedicated to your plan. Quality is monitored constantly through regular claim audits and daily productivity reports.
- In order to ensure quality and objectivity, all claim appeals are adjudicated by a separate department that is staffed by medical professionals.
24/7 Emergency Hotline
We provide a 24/7 emergency hotline number, staffed by bi-lingual medical professionals, specifically trained to handle emergency situations.
Proactive Case Management and Cost Containment Services
Comprehensive reporting capabilities help you to provide information that will enable management to make informed decisions and provide line management with management information by department, cost centre and location in accordance with the company’s requirements.
Data analysation enables Med-Sure Services to measure the performance of your plan and the efficiency of area providers. We then report to you accordingly.
Managing prescription benefits includes claims processing, allowing you to provide convenient and efficient services to your staff. For example, the introduction of a pharmacy benefit can have significant savings in the treatment for routine coughs and colds and other common conditions, thus avoiding the need for costly hospital visits.
Hospital Network Access throughout Thailand
Med-Sure Services has an established network of hospitals and clinics throughout Thailand. Selecting the right hospital can help you make significant savings, whilst your employees are still able to access the best health care providers.
Stop Loss Insurance Monitoring and Management
Whether you are an individual or a large corporation, insurance is for what you cannot afford or don’t want to pay beyond a certain threshold for extraordinary events. By and large, routine medical expenses and the occasional non-life threatening operation, whilst they can be relatively expensive, are still fairly manageable. However, in the case of serious illness the cost can run into many thousands of Thai Baht, possibly millions, causing this level of protection to be required. We can arrange Stop Loss Insurance to cover such catastrophic events.
Full Banking and Accounting Administration
Med-Sure opens a Bank account “in trust” for the company. The account is replenished regularly to insure that there are sufficient funds to pay claims. The process is fully transparent with company HR and Financial staff having full visibility of the account. No fees are deducted for the TPA services until the costs agreed have been signed off for payment.
Membership Handbooks and Cards
As you would expect, Med-Sure provides all necessary support documentation, including handbooks and membership cards for your staff as specified by the employer.
Case Management for Serious or Long-Term Illness
Med-Sure devotes special resources to complex claims that are either high cost or high intensity due to the nature of the illness. Our complex claims team is staffed by medically trained personnel to handle claims that require a higher level of clinical expertise. This includes areas of outpatient therapies such as dialysis, chemotherapy, pain management and speech and physical therapy.
Tangible benefits of Case Management may include:
- Empowering the physician with information – thereby enhancing their ability to make choices concerning interventions, based on cost effectiveness and cost availability information provided by the care manager
- Improvement in management’s ability to assess the cause of adverse outcomes and inefficient processes, and the degree to which treatments, devices, procedures and interventions are comparatively ineffective
- Identification and possible elimination of health care delivery service excesses through claims data analysis
- Reduction of re-admissions, prolonged length of stays, repeat surgery and other costs of corrections, general over treatment and over medication
- Access to a 24/7 Nurse Line, potentially keeping patients accessing the right care at the right time (optional)
- Enhancement of clinical quality through continuous management of process variation, feedback, group process, ownership and delivery system coordination
- Where appropriate, assistance in the development of policy wording and regulatory approvals
Intangible benefits of Case Management may include:
- Improvement in reporting of credible performance measures
- Improving patients’ healthcare understanding
- Improvement in client and patient service and satisfaction, leading to new and retained customers and contracts
- Flexibility in the design of patient services to encompass customer demands
Dependent Eligibility Audits
Some companies generously offer to extend some or all of their employee health benefits to immediate family and dependents. However, you may be surprised to learn that independent membership audits often reveal that up to 10 percent of these enrolments do not meet a plan’s eligibility criteria.
Protection against Abuse
In all walks of life there are those who may try to manipulate the system to take unfair advantage, often to the detriment of the company and their colleagues. As standard procedure we actively monitor claims to ensure that there is no blatantly inappropriate use of the system in a number of areas, ie:
- Inappropriate use of ICD-10 codes for procedures undertaken
- Maximum daily frequency of OPD visits
- Potential cosmetic procedures
- Elective procedures
- Investigational/Experimental procedures and treatment
- Surgical assistant procedures and treatment
Two easy steps to managing your employee benefits plan exactly as you require
1 – Select a Third Party Administrator (TPA)
The first step to becoming self-funded is to retain the services of a qualified and experienced third party administrator such as Med-Sure Services. Med-Sure Services offers a variety of services including access to health care networks, administration and eligibility services, claims processing expertise, benefit plan design and other services that you may not have the resources or expertise to provide alone.
2 – Develop a Benefit Plan
Together we can develop a benefit plan that is designed to meet the healthcare needs of your employees that are at the same time cost-effective to your business.
We are an outsource provider for insurance companies seeking a professional solution to streamline their medical claims administration and to offer their customers a more consistently high level of client service.
Your business is not only competitive, but complex, with many problems to solve. Like many other organizations, you’re probably focused on decreasing costs through administrative efficiency and integrated systems, in addition to improving clinical outcomes. Med-Sure Services provides solutions. Once implemented, the benefits, both tangible and intangible, will increase your competitiveness, satisfying your policy holders.
The cost benefits of case management are well documented. In today’s cost conscious health care environment, case management must prove its economic value and its impact upon clinical outcomes.