	Benefits Administration HSB CLAIMVIEW MEDICAL, DENTAL, & VISION CLAIM ADMINISTRATION HealthSCOPE Benefits' reputation for providing sophisticated, flexible claim administration combined with excellent service is unmatched in the industry. We have the experience, the expertise, the technology, and the people to provide superior administration for self-insured plans, from traditional indemnity to the most complex managed care plan. Our claim processing system is fully-integrated system and is especially well-suited to claim administration providing powerful core functionality. Our technology solutions enable HealthSCOPE Benefits to remain compliant with evolving federal regulations, such as the Health Insurance Portability and Accountability Act (HIPAA). Our sophisticated system provides a paperless claim processing environment and claim administration services via imaging and data capture services. Our Dynamic Resource Management (DRM) software allows us to efficiently manage constantly fluctuating inventories. Our customers enjoy timely access to accurate information twenty-four hours a day, seven days a week with easy web self-service and Interactive Voice Response (IVR) Customer Service resolution. This allows HealthSCOPE Benefits enhanced operational efficiency and creates competitive advantages in the healthcare marketplace. Back To Top HSB Rx Complete HealthSCOPE Benefits' superior information resources, advanced technology, and clinical expertise develops programs that directly and positively impact the health of consumers and help reduce healthcare prescription costs. A large client base enables HealthSCOPE Benefits to negotiate preferred fees with selected Pharmacy Benefit Management (PBM) organizations. Our purchasing leverage allows us to offer our clients substantial administrative savings and prescription discounts on medications purchased through mail service or retail pharmacy network programs. HealthSCOPE Benefits can work with an employer's current prescription drug vendor or offer the services of preferred PBM organizations. HealthSCOPE Benefits Rx Complete services include: • Drug Utilization Review • Prior authorization • Formulary management • Generic substitution Benefits of using such services: • Extremely low administrative fee • Aggressive retail network • Deeply discounted mail program • Account management • Quarterly management reports Back To Top HSB SUPPLEMENTAL SERVICES HealthSCOPE Benefits offers a full range of supplemental services for our clients' administrative needs. These services include COBRA, HIPAA Certificates, Flexible Spending Accounts, and Retiree Administration. Back To Top HSB COBRA ADMINISTRATION HealthSCOPE Benefits offers COBRA Administration to free employers from the time-consuming details of complying with the notification and reporting requirements of the Consolidated Omnibus Budget Reconciliation Act (COBRA). COBRA Administration services include: • Compliance with all notification requirements (including notification by first class mail, with proof of mailing) • Collection of monthly premiums from qualified beneficiaries • Monitoring of late payments and status of the individual's continued eligibility • Maintenance of a toll-free assistance line to Customer Service personnel who will answer questions about COBRA entitlement and options • Record keeping on COBRA activity • Monthly reporting, as needed • Provision of premium coupons to each active COBRA participant • Notification of other vendors of COBRA eligibility or termination of COBRA coverage • Provision of HIPAA Certificates of Creditable Coverage for all COBRA coverage periods To assist you in tracking COBRA activity, HealthSCOPE Benefits will provide you with informative reports on a monthly basis. Back To Top HSB HIPAA CERTIFICATES To help you comply with the requirements of the Health Insurance Portability and Accountability Act (HIPAA), HealthSCOPE Benefits provides complete HIPAA Certificate Administration. These services include identifying employees and dependents whose coverage has terminated and generating corresponding HIPAA Certificates of Creditable Coverage. In addition, we will generate HIPAA certificates upon request. For plans with pre-existing condition limitations, we will contact each new plan participant, obtain the HIPAA Certificate of Creditable Coverage from their previous plan, and calculate the amount of creditable coverage each person should have. This information will then be passed on to the appropriate claims vendor. Back To Top HSB FLEXIBLE SPENDING ACCOUNT (FSA) ADMINISTRATION Flexible Spending Accounts allow employees to reduce the amount of their taxable income by setting aside pre-tax dollars in accounts that can be used to pay un-reimbursed medical and dependent care expenses. HealthSCOPE Benefits offers complete services to provide your employees with the advantages of Flexible Spending Accounts, while relieving you of most administrative details. HealthSCOPE Benefits' Flexible Spending Account Administration services include: • Program Installation/Re-enrollment • Database Management/Reporting • Flexible Spending Account claim adjudication • Account inquiries via IVR, Internet, or toll-free telephone number • FSA quarterly status report notifications mailed to employees • Automated rollover of unreimbursed medical expense claims when HealthSCOPE Benefits handle the claim administration. Back To Top HSB RETIREE ADMINISTRATION HealthSCOPE Benefits provides Retiree Administration for enrolled retirees. HealthSCOPE Benefits Retiree Administration services includes: • Establishment of a Retiree database • Collection of all Retiree medical, dental, and vision (if applicable) premiums • On-going processing of premium payments, late notices, and terminations • Reconciliation and distribution of premiums to appropriate vendors • On-going reporting to assist in tracking Retiree activity • Toll-free telephone line for Retiree inquiries • Distribution of open enrollment information, plan changes, and premium adjustments to Retirees • Updates of eligibility status to all vendors of Retiree plans Back To Top RETIREE HEALTHCARE SAVINGS ACCOUNTS As companies develop new ways to finance retiree healthcare, HSB provides solutions. HSB can manage every aspect of retiree healthcare savings accounts including: • Determining eligible amounts • Managing the accounts with interest • Collecting premiums from members • Providing web updates to members of accruals and deductions • Paying premium sot HMO’s and health plans Back To Top HSB RECOVERY COMPLETE HealthSCOPE Benefits offers a total recovery package for clients who require aggressive pursuit of health plan payments for which another party is responsible. HSB Recovery Complete is a flexible recovery solution that allows you to choose the level of involvement that is right for you. Be confident that your plan is receiving the personal attention and expertise that many customers have come to expect from HealthSCOPE Benefits, a leader in overpayment recoveries. The accurate disbursement of claim dollars is a critical concern for any benefit plan administrators. Claim overpayments can affect any plan's success; therefore, a stringent recovery system should be implemented as part of a plan's overall cost containment program. HealthSCOPE Benefits offers its clients a highly specialized recovery service for a number of occurrences, some of which include: • Subrogation on all third party and no-fault incidents • Coordination of Benefits with other claim payers • Member and Provider Fraud • Overpayments due to: Duplicate claim payments Eligibility errors Non-application of contracted discounts Benefit exclusions and limitations HealthSCOPE Benefits is proud to offer these valuable cost containment services to its clients. The programs can be implemented immediately with initial recovery activity generally beginning within 60 days of the implementation date. CLAIM OVERPAYMENT RECOVERY The recovery of claim overpayments is time consuming and requires diligent efforts. HSB Recovery Complete offers specialized personnel to identify and collect overpayments. This allows claims payers to focus on the adjudication and administration of claims. HealthSCOPE Benefits claim overpayment recovery services include: • Plan involvement and decision making • Computerized detection of claim overpayments • Manual detection of claim overpayments • Quarterly reporting • Dedicated recovery staff Back To Top HSB PLAN DOCUMENT SERVICES HealthSCOPE Benefits provides an in-house service to prepare customized plan documents for your Health Benefits Plan and your Flexible Spending Account/Cafeteria Plan. Our Plan Specialist has extensive experience in benefit plan design, compliance issues, and booklet language development. A Plan Specialist will analyze your plan and incorporate your specific benefits to produce a professional quality draft that reflects your plan information. The Plan Specialist will also analyze administrative issues, such as eligibility, coordination of benefits, and premium conversion plan options. HealthSCOPE Benefits will assess whether your summary plan description includes key provisions required by federal law. This service is provided in response to the Department of Labor's release of the final regulations governing benefit claims procedures and the content of ERISA plan Summary Plan Descriptions (SPD). This review service is designed to assist you by evaluating your current SPD in regard to ERISA regulations and also specific HIPAA and Women's Health and Cancer Rights Act (WHCRA) requirements. A Plan Specialist will conduct this review of your SPD to determine if it contains the plan information required by Federal law. Back To Top HSB STOP LOSS/REINSURANCE SERVICES HealthSCOPE Benefits utilizes a dedicated staff for the administration of stop loss insurance. Whether obtaining a quote or filing a claim, a specialist will be performing the task. Our first goal is to identify the unique needs of our clients and then find the coverage that best meets those needs. HealthSCOPE Benefits works with several MGUs that have demonstrated their ability to provide coverage that meets these special needs, while offering competitive rates. Back To Top STOP LOSS CONTRACTS MARKETING HealthSCOPE Benefits will work with our stop loss vendors in order to procure the most beneficial stop loss quote for the plan. At the time of renewal, we will work with the claims manager, account manager, utilization review vendor and others in order to obtain all of the information necessary to present a complete picture to the stop loss vendor for the renewal quote. After receiving the quotes, we will review the documents for accuracy and feasibility. We will present all options available to the plan. Once the final underwriting has been completed and the quote has been accepted, we will review all contract provisions for accuracy and distribute for the appropriate signatures. We will maintain all contracts and documents related to the stop loss policies. Back To Top

Benefits Administration

HSB CLAIMVIEW MEDICAL, DENTAL, & VISION CLAIM ADMINISTRATION
HealthSCOPE Benefits' reputation for providing sophisticated, flexible claim administration combined with excellent service is unmatched in the industry. We have the experience, the expertise, the technology, and the people to provide superior administration for self-insured plans, from traditional indemnity to the most complex managed care plan.

Our claim processing system is fully-integrated system and is especially well-suited to claim administration providing powerful core functionality. Our technology solutions enable HealthSCOPE Benefits to remain compliant with evolving federal regulations, such as the Health Insurance Portability and Accountability Act (HIPAA). Our sophisticated system provides a paperless claim processing environment and claim administration services via imaging and data capture services.

Our Dynamic Resource Management (DRM) software allows us to efficiently manage constantly fluctuating inventories. Our customers enjoy timely access to accurate information twenty-four hours a day, seven days a week with easy web self-service and Interactive Voice Response (IVR) Customer Service resolution. This allows HealthSCOPE Benefits enhanced operational efficiency and creates competitive advantages in the healthcare marketplace.

HSB Rx Complete
HealthSCOPE Benefits' superior information resources, advanced technology, and clinical expertise develops programs that directly and positively impact the health of consumers and help reduce healthcare prescription costs.

A large client base enables HealthSCOPE Benefits to negotiate preferred fees with selected Pharmacy Benefit Management (PBM) organizations. Our purchasing leverage allows us to offer our clients substantial administrative savings and prescription discounts on medications purchased through mail service or retail pharmacy network programs.

HealthSCOPE Benefits can work with an employer's current prescription drug vendor or offer the services of preferred PBM organizations.

HealthSCOPE Benefits Rx Complete services include:

• Drug Utilization Review

• Prior authorization

• Formulary management

• Generic substitution

Benefits of using such services:

• Extremely low administrative fee

• Aggressive retail network

• Deeply discounted mail program

• Account management

• Quarterly management reports

HSB SUPPLEMENTAL SERVICES
HealthSCOPE Benefits offers a full range of supplemental services for our clients' administrative needs. These services include COBRA, HIPAA Certificates, Flexible Spending Accounts, and Retiree Administration.

HSB COBRA ADMINISTRATION
HealthSCOPE Benefits offers COBRA Administration to free employers from the time-consuming details of complying with the notification and reporting requirements of the Consolidated Omnibus Budget Reconciliation Act (COBRA).

COBRA Administration services include:

• Compliance with all notification requirements (including notification by first class mail, with proof of mailing)

• Collection of monthly premiums from qualified beneficiaries

• Monitoring of late payments and status of the individual's continued eligibility

• Maintenance of a toll-free assistance line to Customer Service personnel who will answer questions about COBRA entitlement and options

• Record keeping on COBRA activity

• Monthly reporting, as needed

• Provision of premium coupons to each active COBRA participant

• Notification of other vendors of COBRA eligibility or termination of COBRA coverage

• Provision of HIPAA Certificates of Creditable Coverage for all COBRA coverage periods

To assist you in tracking COBRA activity, HealthSCOPE Benefits will provide you with informative reports on a monthly basis.

HSB HIPAA CERTIFICATES
To help you comply with the requirements of the Health Insurance Portability and Accountability Act (HIPAA), HealthSCOPE Benefits provides complete HIPAA Certificate Administration. These services include identifying employees and dependents whose coverage has terminated and generating corresponding HIPAA Certificates of Creditable Coverage. In addition, we will generate HIPAA certificates upon request.

For plans with pre-existing condition limitations, we will contact each new plan participant, obtain the HIPAA Certificate of Creditable Coverage from their previous plan, and calculate the amount of creditable coverage each person should have. This information will then be passed on to the appropriate claims vendor.

HSB FLEXIBLE SPENDING ACCOUNT (FSA) ADMINISTRATION
Flexible Spending Accounts allow employees to reduce the amount of their taxable income by setting aside pre-tax dollars in accounts that can be used to pay un-reimbursed medical and dependent care expenses. HealthSCOPE Benefits offers complete services to provide your employees with the advantages of Flexible Spending Accounts, while relieving you of most administrative details.

HealthSCOPE Benefits' Flexible Spending Account Administration services include:

• Program Installation/Re-enrollment

• Database Management/Reporting

• Flexible Spending Account claim adjudication

• Account inquiries via IVR, Internet, or toll-free telephone number

• FSA quarterly status report notifications mailed to employees

• Automated rollover of unreimbursed medical expense claims when HealthSCOPE Benefits handle the claim administration.

HSB RETIREE ADMINISTRATION
HealthSCOPE Benefits provides Retiree Administration for enrolled retirees.

HealthSCOPE Benefits Retiree Administration services includes:

• Establishment of a Retiree database

• Collection of all Retiree medical, dental, and vision (if applicable) premiums

• On-going processing of premium payments, late notices, and terminations

• Reconciliation and distribution of premiums to appropriate vendors

• On-going reporting to assist in tracking Retiree activity

• Toll-free telephone line for Retiree inquiries

• Distribution of open enrollment information, plan changes, and premium adjustments to Retirees

• Updates of eligibility status to all vendors of Retiree plans

RETIREE HEALTHCARE SAVINGS ACCOUNTS
As companies develop new ways to finance retiree healthcare, HSB provides solutions. HSB can manage every aspect of retiree healthcare savings accounts including:

• Determining eligible amounts

• Managing the accounts with interest

• Collecting premiums from members

• Providing web updates to members of accruals and deductions

• Paying premium sot HMO’s and health plans

HSB RECOVERY COMPLETE
HealthSCOPE Benefits offers a total recovery package for clients who require aggressive pursuit of health plan payments for which another party is responsible. HSB Recovery Complete is a flexible recovery solution that allows you to choose the level of involvement that is right for you. Be confident that your plan is receiving the personal attention and expertise that many customers have come to expect from HealthSCOPE Benefits, a leader in overpayment recoveries.

The accurate disbursement of claim dollars is a critical concern for any benefit plan administrators. Claim overpayments can affect any plan's success; therefore, a stringent recovery system should be implemented as part of a plan's overall cost containment program. HealthSCOPE Benefits offers its clients a highly specialized recovery service for a number of occurrences, some of which include:

• Subrogation on all third party and no-fault incidents

• Coordination of Benefits with other claim payers

• Member and Provider Fraud

• Overpayments due to:
Duplicate claim payments
Eligibility errors
Non-application of contracted discounts
Benefit exclusions and limitations
HealthSCOPE Benefits is proud to offer these valuable cost containment services to its clients. The programs can be implemented immediately with initial recovery activity generally beginning within 60 days of the implementation date.

CLAIM OVERPAYMENT RECOVERY
The recovery of claim overpayments is time consuming and requires diligent efforts. HSB Recovery Complete offers specialized personnel to identify and collect overpayments. This allows claims payers to focus on the adjudication and administration of claims.

HealthSCOPE Benefits claim overpayment recovery services include:

• Plan involvement and decision making

• Computerized detection of claim overpayments

• Manual detection of claim overpayments

• Quarterly reporting

• Dedicated recovery staff

HSB PLAN DOCUMENT SERVICES
HealthSCOPE Benefits provides an in-house service to prepare customized plan documents for your Health Benefits Plan and your Flexible Spending Account/Cafeteria Plan. Our Plan Specialist has extensive experience in benefit plan design, compliance issues, and booklet language development. A Plan Specialist will analyze your plan and incorporate your specific benefits to produce a professional quality draft that reflects your plan information. The Plan Specialist will also analyze administrative issues, such as eligibility, coordination of benefits, and premium conversion plan options.

HealthSCOPE Benefits will assess whether your summary plan description includes key provisions required by federal law. This service is provided in response to the Department of Labor's release of the final regulations governing benefit claims procedures and the content of ERISA plan Summary Plan Descriptions (SPD).

This review service is designed to assist you by evaluating your current SPD in regard to ERISA regulations and also specific HIPAA and Women's Health and Cancer Rights Act (WHCRA) requirements. A Plan Specialist will conduct this review of your SPD to determine if it contains the plan information required by Federal law.

HSB STOP LOSS/REINSURANCE SERVICES
HealthSCOPE Benefits utilizes a dedicated staff for the administration of stop loss insurance. Whether obtaining a quote or filing a claim, a specialist will be performing the task. Our first goal is to identify the unique needs of our clients and then find the coverage that best meets those needs. HealthSCOPE Benefits works with several MGUs that have demonstrated their ability to provide coverage that meets these special needs, while offering competitive rates.

STOP LOSS CONTRACTS MARKETING
HealthSCOPE Benefits will work with our stop loss vendors in order to procure the most beneficial stop loss quote for the plan. At the time of renewal, we will work with the claims manager, account manager, utilization review vendor and others in order to obtain all of the information necessary to present a complete picture to the stop loss vendor for the renewal quote. After receiving the quotes, we will review the documents for accuracy and feasibility. We will present all options available to the plan. Once the final underwriting has been completed and the quote has been accepted, we will review all contract provisions for accuracy and distribute for the appropriate signatures. We will maintain all contracts and documents related to the stop loss policies.