Producer Perspectives

Transcription

1 High-Quality Claim Management: What to Expect from a Carrier There are many characteristics that make up a good disability carrier. No one trait, however, is quite as important as a carrier s demonstrated ability to manage claims fairly, accurately, and promptly. High-quality claim management can help you and your clients better predict and manage costs associated with disability claims during renewal negotiations. It can also positively influence claimant satisfaction and support your client s return-to-work strategies. Identifying High-Quality Claim Management: 10 Traits to Look For 1. Early intervention is important to ensure that carriers become involved with the claimant early. A claim examiner will quickly assess the situation and work with the claimant, employer, and attending physician to create a return-to-work plan from the beginning of the claim. 2. A functional-based model focuses on the many abilities that the claimant possesses and is designed to help employees continue to be productive and return to work. In contrast, the diagnosis-based model centers its efforts on the claimant s diagnosis and stages of disease instead of seeking ways to return employees to an active, productive life. Welcome to, The Hartford s group benefits newsletter for producers. This newsletter provides regular updates about our products and services, trends and developments, and other timely information that may be of interest to you and your clients. In this issue: A Year of Progress, A Year of Change 2004 has been a year of progress and growth, challenge and change. What doesn t change is the critical role our producers and employers play in our business success. Help Your Clients Get a GRIP on Retiree Health Benefits You can help employers manage health benefit costs for retirees while providing the support they need with The Hartford Group Retiree Insurance Plan SM (GRIP). International Benefit Solutions The Hartford provides a solution for group life, disability, and accident coverage in Canada. U.S.-based employers with Canadian resident employee divisions can rely on us to help meet their domestic and international group benefits needs. 1

2 High-Quality Claim Management: What to Expect from a Carrier (continued) 3. Experienced claim resources can directly affect a claimant s successful return to the workplace. Every claim requires many steps, from processing the initial claim, to following up during the functionality evaluation, to treatment and rehabilitation. An experienced claims professional can better negotiate this process. The quality of training provided to, or required of, claims examiners is an indication of the carrier s commitment to providing high-quality care. Ideally, you want a claims examiner, a plan, and a carrier that will seek to return claimants to work in a capacity that maximizes both the claimant s health and the productivity of your client s organization. 4. A comprehensive review by an interdisciplinary team, including vocational rehabilitation and clinical specialists, can help conduct a thorough analysis of an employee s disability claim. This team can include nurses, occupational therapists, and physical therapists. 5. Independent physician review is a process that involves using an independent medical network to work with the claimant s attending physicians, at appropriate stages of the claim, to provide objective medical opinions about a disability claimant s functional limitations. 6. Social Security benefits should be carefully tracked so that carriers can provide quantifiable results indicating that all claimants who qualify for Social Security benefits payments will receive them. 7. Technology and service excellence is an integral part of a high-quality claim management strategy. An integrated, technology-based business processing system is more efficient and effective for clients. The system should make it easy for clients to access both the disability carrier and the status of all claims. 8. Return-to-work incentives and assistance help to keep claim costs low by motivating employees and helping them return to work as early and safely as possible. For example, some carriers help pay for work site accommodations and provide job placement assistance and counseling. 9. A fraud prevention program is another indication that the carrier is committed to helping manage the various costs associated with disability. Producers should evaluate whether a prospect s current carrier commits extensive financial, human, and technological resources to fraud-prevention programs. Find out if the carrier has readily available facts demonstrating that its program helps curtail fraudulent behaviors and recapture fraudulently obtained assets. 10. A robust Quality Assurance (QA) program helps validate the level of service and claim management being delivered. Use learnings from the QA results to further improve processes and training programs. When helping your clients find a carrier that has a high-quality claim management program, consider these characteristics as crucial elements for ongoing success in reducing costs and achieving improved employee productivity. Claim Management from The Hartford The Hartford is proud of its more than 60-year history of assisting our disability claimants in their times of need. Claim management at The Hartford was built on the 10 high-quality claim management traits defined in the nearby article, which allows us to manage claims fairly, accurately, and promptly. In addition to paying claims that provide valuable income replacement, we help many people with disabilities to reclaim their self worth and lead active, fulfilling lives. For details about how The Hartford s claim management process can help your clients, please contact your local Sale Representative. 2

3 A Year-End Message from Richard Mucci It s hard to believe another year is coming to a close has been a year of progress and significant growth, of challenge and change. But what doesn t change, year in and year out, is the critical role you play in our success together. I want to take this opportunity to sincerely thank you for choosing The Hartford as your trusted business partner. Through this past year, as in years past, The Hartford has maintained its strong record of financial strength and stability. It is this stability that has made it possible for us to invest in and grow our business. It was a year ago this month that I announced to you our acquisition of CNA Group Benefits. Since December of 2003, we have made great strides in our integration of CNA, including expanding our distribution channels, enhancing our product and services portfolio, building our claim management capabilities, and creating a larger, stronger team to better serve the needs of you and your clients. And beyond our integration efforts, we continue to enhance and improve our product portfolio and business processes for our specialty markets like Integrated Medical Solutions, Association Affinity, and Senior Medical. Our team and our company are committed to doing business the right way and keeping our promises to our customers as we have for almost 200 years. In 2005 and beyond, you can count on The Hartford to deliver industry-leading customer service and products with the integrity on which our reputation is founded. Again, thank you for your business and your trust in The Hartford Group Benefits. We take pride in being your insurance partner and providing you with the group disability and life products your clients value as part of their income protection plans. I wish you a happy and healthy holiday season and a prosperous New Year! Sincerely, Richard L. Mucci Executive Vice President Group Benefits Division Our company is committed to doing business the right way and keeping our promises to our customers as we have for almost 200 years. Richard L. Mucci, Executive Vice President, Group Benefits Division 3

4 Help Your Clients Get a GRIP on Retiree Health Benefits Employers can manage health benefit costs for retirees while providing the support they need with The Hartford Group Retiree Insurance Plan SM (GRIP) It s a challenge. Employers want to do the right thing in providing benefits for retired employees who helped build their business. At the same time they face increasing benefit costs, including retiree medical benefits, which continue to outpace inflation and impact the bottom line. The Hartford Has a Solution GRIP is a fully-insured program for retirees aged 65 and older that can help make retiree benefit costs more manageable and predictable, while also helping manage or even reduce accounting requirements and responsibilities related to retiree benefits. The plan offers employers easy administration and flexibility; it gives retirees coverage for expenses not typically covered by Medicare. The plan has many appealing features, including: Integration with Medicare. For retirees aged 65 and older, the insurance plan is designed to integrate with Medicare, covering many of the deductibles, co-payments, and other medical expenses not currently covered. Flexible eligibility. Medicare-eligible retired employees, age 65+, are eligible. Coverage is available for spouses, widows or widowers, domestic partners, and children of eligible retirees. Small group coverage. For small groups, as few as two retirees can be written in one of our trust plans; a minimum of 100 covered lives are required for a customized stand-alone plan. Group coverage. Plans are available only through employer-sponsored groups, including corporations, partnerships, individual employers, labor unions, religious organizations, and most government agencies or departments. Employer/retiree contributions. Plans are available to accommodate contributory and non-contributory plans. All plan options (including defined contribution) and vesting schedules are available. Prescription drug coverage is available. Options include a variety of deductibles, co-payments, and calendar-year maximums. Coverage is provided using an open formulary, which includes a preferred list and mandatory generic, through both retail and mail order. Find Out More Contact one of our local sales representatives to learn more about our solutions for retiree health benefit challenges and confirm which plans are available in your state. You can also contact one of our regional sales directors: Northeast Alexandra Taylor , Ext Alexandra.Taylor@hartfordlife.com South/Mid Atlantic Carol Braswell Carol.Braswell@hartfordlife.com Mid West Ron Rozgonyi Ronald.Rozgony@hartfordlife.com West/Southwest Jill Cooke Jill.Cooke@hartfordlife.com The Benefits of GRIP GRIP gives you the solution to a common problem for your clients how to cover retiree medical benefits. It also offers many benefits to both employers and retirees. Benefits for Employers More control over and potential to reduce overall health insurance costs by segmenting age 65+ retirees into a fully-insured program; helps to reduce retiree-to-active ratio. Easier administration because The Hartford s approved third-party administrator handles this often time-consuming task, freeing up HR resources to handle other priorities. Administrative and billing options to allow your clients to adjust their contribution schedule to manage commitment and costs for current and future retirees including list bill to employers, direct bill to retirees, or a combination of these options. Range of insurance plans available nationally. Benefits for Retirees Coverage that integrates with Medicare, helping to pay for many of the deductibles, co-payments, and out-of-pocket medical expenses not covered by Medicare. Hassle-free electronic claims and dedicated customer service support, with tools specifically designed for, and training aimed at, supporting retirees. Freedom from managed care networks choice of doctors; available nationally. 4

5 International Benefit Solutions Your U.S.-based clients with Canadian resident employee divisions can rely on The Hartford to meet both domestic and international group benefits needs through International Benefit Solutions. The Hartford s International Benefit Solutions provides a competitive portfolio of benefits, including group life, disability, and accident coverage, for U.S.-based clients with Canadian resident employee divisions. In addition, The Hartford can help you understand important nuances in the Canadian benefits landscape including regulatory, language, and taxation differences that may affect your clients. Canadian Employee Benefits Are Valued Life and disability benefits are an important aspect of Canadian employees overall benefits package. Responses to the 2004 Aventis Healthcare Survey show that 94% of Canadians consistently rate their disability plan features as very important or somewhat important. This percentage is on par with both dental and medical benefits. 1 Canadian Benefits Have Distinctive Features Employee benefits in Canada differ from the United States in many ways. Understanding these difference is critical before expanding life and disability benefits into Canadian divisions. Life Insurance in Canada The Canadian Life and Health Insurance Association defines minimum standards required for group life insurance. Notable differences from U.S. benefits include: A portability option is not traditionally offered. Conversion of coverage is limited to a $200,000 maximum. Employees are taxed on all employer contributions for employee and dependant group life (first $50,000 imputed income exemption does not apply). An employee cannot lose coverage simply due to a change in insurance carriers. No loss/no gain is the rule in Canada. Disability Insurance in Canada Most employers provide employees with some level of disability income replacement coverage. The focus is more frequently on LTD, while many employers depend on Employment Insurance (providing temporary financial assistance for unemployed Canadians while they look for work or upgrade their skills) to cover STD benefits. Other notable differences from U.S. benefits include: Benefits in Canada terminate at age 65. There is no Age Discrimination in Employment Act schedule. Mental nervous and substance abuse are not limited to 24 months. The Canadian Pension Plan is equivalent to the U.S. Social Security system. The vast majority of cases in Canada have a primary offset only. The Hartford Can Help The Hartford provides a strong solution for U.S. employers in the Canadian marketplace. For more information about Canadian benefits or to request a quote, please contact your local Sales Representative. About The Hartford The Hartford offers a wide range of products and services with plan design choices to meet your needs, including: Short Term Disability (STD) Long Term Disability (LTD) Integrated STD/LTD Term Life AD&D Travel Accident Senior Medical Stop Loss Most products are available on a contributory and non-contributory basis. The Hartford is The Hartford Financial Services Group, Inc., and its subsidiaries, including issuing companies Hartford Life and Accident Insurance Company, Hartford Life Insurance Company, and CNA Group Life Assurance Company (pending name change to Hartford Life Group Insurance Company ). 1 The 2004 Aventis Healthcare Survey conducted by Ipsos-Reid. 5