Loomis Presentation

Administrative Services

Client Proposal

The Loomis Company850 N. Park RoadWyomissing, PA 19610

Brian Greenwood770-391-1059www.loomisco.com

Annapolis, MD

Portland, OR

Ft. Lauderdale, FL

Las Vegas, NV

Your Partner in Healthcare

Wyomissing, PA*

• Business Insurance Magazine Ranks The Loomis Company in the “Top 100” of U.S. Insurance Brokers

Eatontown, NJ

Page 2Copyright © 2009 The Loomis Company

Ft. Lauderdale, FL

*Corporate Headquarters

• “Top 10” of Third Party Administrators

• SAS-70 Audit

• Now offering CIGNA network

What Are Your Issues?

Technology / Online Tools?

Claims Administration / Service?

Copyright © 2009 The Loomis Company

Claims Administration / Service?

Flexibility & Customization?

Medical Management?

Networks?

Costs?

Flexibility

The Loomis Company is able to respond rapidly to changes in your business, play an active role in shaping those changes, and provide options when the need arises.

• Medical Claims • Dental Claims• Vision Claims • Short Term Disability • COBRA

• Data Feeds to External Carriers• Custom Payroll System Data Feeds• Employee Online Enrollment System• Data Services for State/Federal

Mandated Programs


• COBRA• HIPAA• FMLA• HRA (Health Reimbursement Accounts)• HSA (Health Savings Accounts)• High Deductible Health Plans• All Section 125 Accounts• Consolidated Premium Billing• One Source Enrollment Maintenance• On-site Enrollment

Mandated Programs

Inbound For:ProvidersMembers

Inbound For:PPO NetworksEDI Clearing Houses

Internet

Paper Claim

Scan & Data Entry

Scan & OCR

Electronic Data Interchange

Data Validation Work Teams

• Data Validation• Eligibility Team• Provider Team• Benefits Pricing

Post Office Box

The Life of a Claim

Improving accuracy and efficiency in processing claims while preventing unnecessary losses

Open & Sort


Houses

Electronic Payment

Payment Mailed

Fax

Work Team Categories

Auto Adjudication

Analyzing risk and detecting suspicious activity with every new transaction

INVESTIGATION

• COB

• Student Status

• Third Party Liability

• Pre-Existing

MEDICALMANAGEMENT

• Coding Review

• Emergency Room Review

• Possible Cosmetic Procedures

DENTAL

• Tooth Already Extracted

• Denture Review

• Filling Review

• Coding Review

COST CONTROL

• Savings & Recovery

• Internal or External Re-pricing

• Fraud & Abuse Prevention

EXAMINER

• Plan Benefits Review

• Managed Care Information

LOOMIS INNOVATIONS

• Fraud & Abuse Prevention

• Repricing Optimizers

• Decision Support Systems

Electronic Claim File

Fee Schedules

IVR

• Employee Access

• Personalized Greeting

• Provider Access

IVR

• Network Discounts

• Out-of-Network Claim Management

• Administrative Services

Single Entry Point – High Impact

Loomis Innovations

Average of 50-60%with potential PPO discounts up to 80%


• Provider Integrity Program

• Intelligent Claim Surveillance

• ClaimsGuardSM

Loomis Healthy People

• Predictive Modeling

• Clinical & Financial Plan Modeler

• Data Warehousing & Web Based

Reporting (Medstat Reporting)

• Evidence-Based Care Management

with potential PPO discounts up to 80%

5-10%

2-4%

Managing Your Plan

Actual Claims

Turnaround Time

% Paid Medical

% Paid Dental

0-2 Days 16% 30%

7 Days 87% 92%

We pride ourselves on superior customer service, both to your members and to your human resources staff.

Benefit Inquiry22%

Call Reasons


15 days 95% 99%

30 days 99% 100%

Average Abandonment Rate 3%

Average Speed to Answer 21 seconds

Claims Totals

Financial Accuracy 99%

ClaimStatus58%

Pre-Certification

8%

Eligibility7%

Claims Mailing Address

2%All Others

3%

Advanced Technology Solutions

Electronic Funds Transfer Direct to Provider

Most Used Facilities The Loomis Company

837 HIPAA-Compliant Claim File

835 Electronic Remittance Advice (Matches EFT to Hospital)


24/7 Online Access to Claims and Eligibility Information Via GroupWeb

Electronic Funds Transfer Direct to Provider

Loomis Provides Direct Deposit for Employee Medical, Dental, and

FSA Claims

BankGroupWeb

The Executive Summary ReportGenerated quarterly, it provides a snapshot view of the entire claims experience. Key elements include prescription drug expense as a percentage of total medical benefits, PPO discounts, medical claims cost per employee, number of admissions and length of stay, and compares current plan year data to prior year data. This

Reporting Suite


year data to prior year data. This information assists with decision making when plan design changes are considered.

The Aggregate Monthly Status ReportYear-to-date enrollment and monthly paid claims data, it itemizes claims that are reinsured by both the aggregate and specific stop loss coverages.

• Cost and Use Key Indicators

• Cost Benchmark Comparison

Medical Management - Medstat


• Preventive Screening Rates

• Preventive Screening Benchmarks

• Rx Cost and Use Analysis

Predictive Financial Modeling


Member Support

• Welcome Packets

• ID Cards

• Website Access

• Dedicated 800 Line

• Dedicated Claims Adjusters


• Dedicated Claims Adjusters

• Dedicated Account Manager

• Member Advocate

• Call and Correspondence Tracking

• Call Reason Report

• Call Auditing

• Customer Service Surveys

Benefits/Debit Card

The Benefits/Debit Card is a debit card that can simplify the process of paying for eligible expenses under pre-tax benefit accounts. It is an alternative to the traditional paper method of filing claims. Employees can use the card at qualifying merchant locations wherever MasterCard® or Visa® is accepted – from physician and dental offices to pharmacies and vision service locations. The card allows them to pay for eligible expenses at the point of service.


The ease of use at the point of sale and the reduced burden of having to pay money out-of-pocket, completing a claim form and waiting for a reimbursement has proven to be extremely popular benefit plan participants.

• On average, employers realize a 25% increase in participation in pre-tax benefit accounts.

• A 28% increase in per-employee contributions is a result of using the card

• These increases can significantly impact employer’s bottom line due to the savings incurred in FICA taxes.

• $1.50 PEPM

Internet Tools

With LoomisWeb, claims information can be accessed 24/7

Users can sign on, access and update:

• Medical provider search engines

• Eligibility, coverage and EOBs that have been processed

• Claims currently in the system and claims that have been processed and paid

• Request ID cards


• Request ID cards

• Download claim forms

• Rx vendor Internet services

• Research health-related issues

• Employee eligibility information

• Enrollment of new employees

• Patient information

• Status of claims

• Claims data at the employee level

• Changes or terminations

• Intuitive Rules-Based Enrollment

• HRA Support

• Electronic Questionnaires

• Participant Contribution Calculation

Enhanced Benefits Portal


Calculation

• Plan Comparison Tools

• Single Sign on Connectivity

• Enrollment Capture for all Products

• Electronic Feeds to Populate Payroll System

Key Advantages

• Provides support for all benefits offered by employers.

• Assists in both open enrollment and employee enrollment maintenance process.

• Ability to interface with employer’s payroll system.

• Supports a single sign on (SSO) for the employee.


• Supports a single sign on (SSO) for the employee.

• Security level to specify benefits for a class of employees.

• Allows for access to real-time reporting for eligibility.

• Simple premium administration allowing single payment by client and distribution to applicable vendors.

Administration Section

Customized navigation bar

based on client’s needs.

Welcome screen lists


Welcome screen lists transactions and any actionable items as

well as current activity.

Customized links for connections to other benefit vendors

All benefit documents are available for

instant access by the employee.

Reporting Functions

Client-defined reporting capability


reporting capability to provide listing

based on parameters selected.

Employee Enrollment

Text can be tailored to client’s needs.


Note the color coding: green active

enrollment, red not enrolled, and yellow pending enrollment

Conditional enrollments will be

held pending receipt of required item (s).

IDENTIFYexisting and potential risk exposures using a collaborative approach that allows us to thoroughly understand covered people.

ENGAGEcovered people and their attending providers, allowing us to assist them with the right health care information and



assist them with the right health care information and services for their particular situation.

MONITOR/REPORTyour progress using a full spectrum of financial and clinical reporting capabilities.

RESULTS:Healthier people, improved productivity, and reduced health care costs.

Why is prevention so important?


As much as 70% of all medical costs and

In the 20 years from 1980 to 2000 obesity prevalence increased

50% of the covered population are

presymptomatic or asymptomatic for


medical costs and absenteeism are

preventable.

prevalence increased from 14.5% to 30.4% -

obesity is a pre-cursor to a variety of morbid conditions.

asymptomatic for conditions that could be controlled or better

managed through lifestyle changes.

Client Results

111 participants with hypertension, resulting in 6.6% of claims

11 participants with COPD, resulting in .5% of claims

Our predictive modeling tools applied to Client’s claims data identify existing and potential healthcare issues, which allows us to design


41 participants with asthma, resulting in 2.4% of claims

56 participants with diabetes, resulting in 3.3% of claims

41 participants with osteoarthritis, resulting in 2.4% of claims

allows us to design focused case and care management plans specific to the individual’s personal risks.

Predictive Modeler

Condition

No. of Patients with Projected Annual Cost

$1,000 to $5,000 $5,001 to $10,000 $10,001 to $25,000

Hypertension 21 17 17


Asthma 20 6 4

Diabetes 4 8 7

Arthritis 2 7 7

Osteoarthritis 2 5 6

Patient Summary


The Loomis Prescription Program

• 100% of rebates returned directly to client

• Rebates up to $5 per script

• Competitive AWP discounts

• Comprehensive clinical programs included at no additional charge

• Personalized participant communications that educate


• Personalized participant communications that educate and reduce costs

• 64% generic dispensing rate – with best performing accounts achieving over 70% generic utilization

• Specialty pharmaceutical management through the nation’s largest specialty pharmacy

• People get drugs at pharmacy mail-order price

• Mail order deliveries shipped from closest processing center to the individual’s address.

The Loomis Prescription Program

MAIL

BRAND AWP -24%

GENERIC AWP -58%

DISPENSING FEE $0.00 per claim

ADMINISTRATION FEE $0.95 per claim

RETAIL

NETWORK National


BRAND AWP -16%

GENERIC* MAC

Non MAC: AWP -16%*Generic effective rate guarantee of AWP – 55% (MAC and Non- MAC Combined)

DISPENSING FEE $1.75 per claim

ELECTRONIC CLAIM ADMINISTRATION FEE $0.95 per claim

MANUAL CLAIM ADMINISTRATION FEE $0.95 per claim

REBATES

MAIL Client will receive 100% of the rebates collected.

RETAIL Client will receive 100% of the rebates collected.

SPECIALTY MEDICATIONS

AWP -16% + $0.00 Dispensing fee Administration Fee $0.95 per claim

Integrated Network Solutions

One Card Does It All!

Administration fee savings and PPO discounts have earned us “preferred TPA” status with several stop-loss carriers.

Specific Deductible: $125,000


Specific Deductible: $125,000

Contract: 24/12

Aggregate Attachment Point: $15,500,000

Loomis Trend Factors for 2006-2007:With Managed Care – 11%With HealthyPeople – 6%

Implementation Process

• Weekly calls/meetings

• Handle run-out data requirements

• Review and update SPD

• Eligibility files to all appropriate


• Eligibility files to all appropriate vendors

• Identify and build banking/funding arrangements

• Build reporting needs

• Build ID card

• Review plan for nuances

Why Loomis?

If your goal is to proactively manage risk rather than simply rely on discounts and claims payment alone, we can help you with:

• Programs to prevent hospitalizations and catastrophic events with early interventions

• Data gathering, interpretation and analysis, making


• Data gathering, interpretation and analysis, making recommendations specific to your needs

• Online, real-time reporting that provides instant access to clinical information

• Controlling stop loss costs

• Management of Rx costs

• Our personal commitment to your members

Our Clients Include…


Brian GreenwoodThe Loomis Company4780 Ashford Dunwoody RoadSuite A125Atlanta, GA 30338Phone: 770-391-1059


www.loomisco.com

Documents

Loomis Presentation