Services. What we do for your plan.
Your health plan is likely one of the largest bills your company pays, and it usually arrives as one premium with no explanation. Ethos Benefits opens it up and runs it with you, to a fiduciary standard of care, with every service reporting to your committee under the Fiduciary Framework™.
Three problems we fix first.
- Getting brokered. Incentives that point the wrong way.It starts with not knowing how, when and how much your advisor is paid. When the advisor earns more as the plan costs more, the incentives point away from you. Every engagement starts by putting that on the table.
- A closed box. Thousands of claims, one premium.Thousands of claims reduced to one annual premium with no explanation. You would not accept that accounting anywhere else in the business. We open the box and account for where the money goes.
- No fiscal controls. Switching carriers is not a strategy.The idea that a health plan’s cost can’t be controlled. Changing carriers without a plan changes nothing. The real question is what is being done about how often claims happen and how expensive they are.
Fiduciary governance The committee and the record.
How your benefits committee is set up, run and documented, so every decision about the plan can be shown to be prudent.
- Fiduciary governanceEthos Benefits sets up and runs your health plan benefits committee, with a charter, quarterly meetings, minutes and a record of every decision and why.
- Fiduciary liability insuranceEthos Benefits helps plan sponsors review and size fiduciary liability, D&O and E&O coverage for the people who make decisions about the health plan.
Procurement and contracts Every vendor, chosen and held to account.
How vendors are selected, contracted, measured and replaced, using the same scored, documented process for every line of coverage.
- Procurement and contractsEthos Fiduciary Procurement is how Ethos Benefits runs RFPs for PBMs, TPAs, stop-loss and other plan vendors, scores every bid and negotiates the contract.
- Pharmacy and PBMEthos Benefits reviews your PBM contract and pharmacy spend, finds where spread pricing and rebates go, and helps your committee decide what to change.
- Stop-loss procurementEthos Benefits markets, places and renews stop-loss coverage for self-funded health plans, and audits the contract so the policy pays when it should.
- TPA and administrative contractsEthos Benefits runs TPA and ASO procurement for self-funded health plans and redlines the administrative services agreement before your company signs it.
- Vendor managementEthos Benefits holds your health plan vendors to their contracts with service level agreements, performance guarantees, KPI scorecards and quarterly reviews.
- Life, disability and absenceEthos Benefits markets and manages life, AD&D, disability, leave and absence administration, dental, vision and voluntary benefits alongside your health plan.
Data and analytics Your plan’s data. All of it.
Your plan’s claims, pharmacy and eligibility data, owned by your company, read directly and turned into decisions.
- Claims analyticsYour company owns its health plan data. Ethos Benefits connects your claims and pharmacy data to analytics and reviews it with you every month.
- Benchmarking and modelingEthos Benefits benchmarks your plan design and contributions against similar employers and models the cost and affordability of every change before you make it.
- Claims, billing and eligibility auditsEthos Benefits audits your health plan invoices and eligibility, coordinates claims audits with your vendors, and tracks every recovery to completion.
- Underwriting and rate analysisEthos Benefits checks the underwriting behind your renewal, projects claims from your data, and builds premium equivalent rates for self-funded plans.
Compliance Every obligation, owned and proven.
Every federal requirement for your health and welfare plans, with an owner, a due date and proof it was done.
- ComplianceEthos Benefits keeps your health and welfare plans compliant with ERISA, the ACA, COBRA, HIPAA, mental health parity and the CAA, with every item proven.
- ERISA complianceEthos Benefits keeps your health and welfare plans ERISA compliant: plan documents, SPDs, required disclosures, Form 5500, bonding and provider disclosures.
- ACA compliance and reportingEthos Benefits keeps your company ACA compliant: employer mandate, affordability, SBCs and PCORI fees, plus Forms 1094-C and 1095-C as an added service.
- Nondiscrimination testingEthos Benefits runs Section 125, dependent care and Section 105(h) nondiscrimination testing so your plans keep their tax advantages for every employee.
- Mental health parityEthos Benefits coordinates your plan’s NQTL comparative analysis under the Mental Health Parity and Addiction Equity Act and keeps it current.
Strategy and renewals A plan, not a renewal.
The three to five year direction for your plan, and every renewal and cost decision made against it.
- Benefits strategyEthos Benefits builds a three to five year strategy for your health and welfare plans: goals, plan design, vendor direction and targets your committee tracks.
- Renewals and marketingEthos Benefits starts your health plan renewal at least six months early, markets it to carriers and vendors, and puts every option in front of your committee.
- Cost containmentEthos Benefits evaluates and contracts cost containment for your plan: reference-based pricing, direct contracts, direct primary care and pharmacy programs.
- Mergers and acquisitionsEthos Benefits reviews employee benefits and health plan risk in mergers and acquisitions, and plans the integration so employees keep coverage on day one.
- PEO evaluationEthos Benefits helps employers decide whether to join, stay in or leave a PEO for benefits by comparing the full cost and control against a plan of your own.
- Global benefitsEthos Benefits helps U.S. employers with employees abroad review international benefits, compare them with local practice and govern them with the U.S. plan.
Service and your people Help for every employee.
Administration, communication and one-on-one help for the people who use the plan.
- Benefits administration and technologyEthos Benefits builds and audits your benefits administration platform, sets up carrier and payroll file feeds, and manages carrier transitions.
- Employee communicationsEthos Benefits runs year-round benefits communication and open enrollment: email, text, meetings, one-on-one enrollment help and a two-way message line.
- Employee advocacyEthos Benefits gives your employees real help with health care: choosing providers, understanding costs, fixing claims and bills, and financial assistance.
- Medicare coordinationEthos Benefits helps your company and employees coordinate Medicare with the group plan: creditable coverage notices, secondary payer rules and timing.
- HR supportEthos Benefits gives your HR team access to an HR hotline, handbook help, document review and training, alongside your benefits support.
How an engagement runs.
Every engagement runs the same five phases, in order, before anything about your plan changes: Risk Reality, Anatomy of a Plan, Invisible Invoice, Ground Truth and the Fiduciary Framework™. After that, a named team runs the plan with you all year.
See what your plan is really costing you.
A Strategic Analysis starts with your plan documents and your broker agreement, then shows you what your plan costs, where the risk sits, and what a committee would decide with the full picture.