Atlanta Headquarters 3080 Premiere Parkway Duluth, GA 30097-4904 www.groupresources.com 770.623.8383 770.623.4022 fax Houston Office 5599 San Felipe Suite 555 Houston, TX 77056 713.439.0882 713.439.0256 fax Dallas Office 2100 Ross Avenue Suite 830 Dallas, TX 75201 214.922.8880 214.922.9802 fax Nashville Office 301 S. Perimeter Park Dr. Nashville, TN 37211 615.781.4268 615.781.4269 fax PAGE 12 PAGE 1
Integrated Third-Party Administration That Cares, Connects and Controls Costs. Whether you re a large public corporation or a small private company, a hospital, a municipality or a school district, you ll find Group Resources to be a third-party administrator in which you can have complete confidence. At Group Resources, our goal is to provide each of our clients with superior benefit management services that lead to healthier employees and healthier businesses. What this means for you is a highly personalized, and flexible employee health benefit plan that is designed to produce quality healthcare at a competitive rate... enabling your health plan to maintain financial stability while creating unparalleled satisfaction among your plan participants. years of experience in claims adjudication, so you can be sure that you and your employees will benefit from efficient claims management and administration. Claims are typically adjudicated within 10 working days, with an accuracy rate in excess of 99%. A dedicated Member Services Representative will also be assigned to your account to handle all of your eligibility transactions and administration. Direct Access and Personal Contact. Your employees will speak directly with the Benefit Advisor who processes their claims, and they can access claims status via a touch-tone phone. What s more, with GRI Direct Access, you, your employees and providers will have 24/7 web-based access to vital information. "When I visited Group Resources facility, I sensed their service levels would be high. Now, speaking from actual experience, I can say that they have exceeded all my expectations..." Create the Plan That s Right For You. Right from the start, we ll assign an Account Manager to work with your broker, agent or consultant and our sales representative to help fine-tune your product design. Have Confidence in Our Reliable Benefit Partners. Your comprehensive plan will include all the components you need to achieve a fully integrated benefit solution provider networks, pharmacy benefit management companies (PBMs), utilization review services, stop-loss coverage, laboratory services and more. To enhance your comfort level, we work only with trusted, proven premier benefit partners: National PPOs, such as Private Healthcare Systems (PHCS) and Beech Street, Regional PPOs, such as SouthCare and Texas True Choice, PBMs, such as Express Scripts, PartnersRX, PharmaCare and ProCare, and LabOne, the largest single-site diagnostic testing laboratory in the country. When you choose Group Resources, we ll assign an Account Manager and a Business Unit to handle all the activity for your company. Under the leadership of a Business Unit Director, a dedicated Benefit Advisor or team of Benefit Advisors will be assigned to your account along with a full team of dedicated support professionals. On average, our Benefit Advisors have more than 12 With Direct Access, employers can: View employee information View claim status Change coverage Enroll employees Link to PPOs, PBMs, and other vendors Download forms & documents Run reports With Direct Access, employees (at the discretion of the employer) can: Access their Summary Plan Description View benefit information View claim status Request coverage changes Re-enroll Link to PPOs, PBMs, and other vendors Download forms & documents With Direct Access, providers can: View benefit information View claim status Download forms & documents PAGE 2 PAGE 11
Not Just Good Business. Good Medicine. In 1981, when Thomas S. Byrd, RHU, established Group Resources, he wanted to create a third-party administrator that was dedicated to providing sound plans and solid performance for clients and their employees. Today, as one of the most highly respected and largest privately held third-party administrators in the country, it is still our goal to provide you a superior product and unparalleled service. To that end, we invest in our two most important resources: our people and our technology. We value your confidence and work hard to earn it, applying exceptionally high corporate standards of quality, knowledge and innovation. We work exclusively through highly respected agents, brokers and consulting firms. And, because great relationships are vital to your success and ours, we demonstrate dedication, fairness and respect for our clients, brokers and employees. For plans that protect your company and your employees, all you need to know is our name: Group Resources. To learn more about Group Resources and how we can help your business or institution achieve cost-effective benefit plans both you and your employees can feel good about, visit www.groupresources.com or call the Group Resources office nearest you. Atlanta Headquarters 3080 Premiere Parkway Duluth, GA 30097-4904 www.groupresources.com 770.623.8383 770.623.4022 fax Houston Office 5599 San Felipe Suite 555 Houston, TX 77056 713.439.0882 713.439.0256 fax Dallas Office 2100 Ross Avenue Suite 830 Dallas, TX 75201 214.922.8880 214.922.9802 fax Nashville Office 301 S. Perimeter Park Dr. Nashville, TN 37211 615.781.4268 615.781.4269 fax With all the advantages of Group Resources, I m convinced we re finally offering the best benefit plan we can afford... PAGE 10 PAGE 3
We Show You How To Balance Quality Care and Managed Care. With Group Resources, the complexities and escalating costs associated with our corporate benefits program have seemed to disappear... You want your employees to have the best medical benefits possible. Yet, in the real world of rising medical costs, it s not easy for your business to maintain its equilibrium, balancing what s best for employees against what s best for the company. That s why, at Group Resources, we make use of the most advanced tools and the highest-quality partners, to give your employees the health care they deserve, while keeping a tight rein on your bottom line. No matter how small or unique your operation, we can design and maintain a low-cost healthcare solution that rivals those of Fortune 500 firms. We Take the Pain Out of Managed Care. All too often, it seems, managed care produces a plethora of painful choices. But, with Group Resources, you can increase your comfort level, thanks to our managed healthcare networks and a host of comprehensive, leading-edge management tools. Our managed healthcare networks deliver both significant preferred provider discounts and substantial network utilization. PPO network evaluation tools, including PPO discount evaluation and utilization reporting, ensure that your PPO is keeping up with employee healthcare trends. To further ensure you and your employees are getting the most for every healthcare dollar, our relationships with proven Utilization Review partners incorporates pre-admission certification, continued stay review, case management and other claims management services. Utilization Management: Pre-admission certification Elective and emergency hospitalizations are screened to determine medical necessity and setting appropriateness. Continued stay review Patient s condition and treatment plan are evaluated, to determine medical need for continued hospitalization and consider more cost-effective treatment settings, without sacrificing quality care. High-risk pregnancies are monitored to ensure that the appropriate level of care is delivered. Inpatient and outpatient mental health/substance abuse cases are reviewed to determine appropriateness of setting and treatment. Case Management: Nurses manage patient care through assessment, planning, implementation, coordination, monitoring and evaluation of appropriate cost-effective treatment. Caring, compassionate and directed case management works in the best interest of patients affected by serious accidents and illnesses, chronic care, high-risk pregnancy and neonatal conditions, and mental health/substance abuse cases, including medication management. Intracorp provides early identification of short-term, high-cost cases and determines level of intervention to be applied. Out-of-Network Claims Negotiation: Negotiated discounts with out-of-network providers result in significant savings in areas such as: high-dollar, non-ppo facilities; multiple surgery billings; and chronic use items (DME, injectables, dialysis, orthotics and infusion therapy). Partnership with national PPO networks allows us to access premier national networks on a "percentage-ofsavings" basis, for best possible discounts when they are not the primary PPO. Our partner, Innovative Health Strategies, provides access to direct negotiation and out-of-network direct contracting on a "percentage-of-savings" basis. Discount Outpatient Laboratory Services: Partnership with LabOne increases benefits and offers substantial savings over current lab costs. Employees have access to lab work with no out-ofpocket fees, encouraging use of this voluntary program and reducing your plans lab benefit costs. Employee presents LabCard at physician s office or a LabOne "contracted" collection site. LabOne picks up specimens, performs tests, and sends results to physician, usually the next day. Pharmacy Benefit Management (PBM): Choose from a number of PBM arrangements offered through multiple vendors. Regular negotiation of PBM contracts ensures quality service and discounts, using prescription drug cards and mail-order pharmacies. Agreements with several preferred vendors combine cost-conscious formulary with deep discounts off average wholesale price (AWP). PAGE 4 PAGE 9
We ve Got Your Business and Your Employees Covered. Outsourcing benefits administration to Group Resources not only reduces costs, but is the ideal solution for increasing employee health and productivity... Safeguarding Your Self-Funded Plan With Stop-Loss Coverage. More than 70% of U.S. employers have some form of self-funded benefit program for their employees and with good reason. As health care costs spiral higher, selffunding offers the potential for savings, in instances where claims are below expectations. In addition, selffunding gives you, the employer, the flexibility to design your own benefit plans subject to federal law, but not subject to state-mandated benefits. Stop-loss coverage provides a safety net that will protect your business, giving you a predictable level of risk from your self-funded plan. "Specific" coverage, sometimes referred to as catastrophic coverage, limits your liability on any one individual, while "aggregate" stop loss reimburses the plan when the total of all paid claims exceeds your annual maximum threshold. At Group Resources, our sales and marketing professionals have extensive expertise in stop-loss coverage. We ll help you determine the appropriate stoploss limits for your business and your benefit plans, balancing the right level of protection for your company against your stop-loss premiums, to ensure that your business remains healthy. Be Confident in Your Compliance. Because compliance is one of your biggest challenges, we re committed to supporting the level of diligence and review expected by ERISA, HIPAA and the Department of Labor, as well as keeping abreast of current case law. More than 1,000 new laws, regulations and court decisions are enacted each year, all affecting your employee benefit plans. To assist in keeping your plan in compliance, we have ERISA council on retainer to help guide your plan through the legal maze. With Group Resources, you have access to a comprehensive range of integrated services that ensure your plan is solid, robust and flexible. Comprehensive Administrative Services In addition to managing claims and supporting 24/7 access for you and your employees, your dedicated Group Resources team regularly analyzes your current benefit plan s performance, reviewing diagnoses, services and utilization patterns and looking for opportunities for improvement. Our benefitinformatics TM benefit plan modeling makes use of leading-edge technology to develop and analyze both your current plan and multiple other plan scenarios, to determine which plan is best suited for your business, your employees and your goals. In addition to a user-defined summary and drill-down options, benefitinformatics TM capabilities include: Utilization & cost analysis by provider, procedure or diagnosis Information on key health-service groups Expenditures by time period Prescription drug utilization by classes & specific drug Benchmark comparisons Trend analysis by diagnosis or age group Flexible data query Graphical tools The ability to export to spreadsheets or database files We ll also issue monthly claims Management reports, including: Aggregate claim reports Experience summaries by employee & dependent, as well as by type of coverage Utilization reports Check registers Shock claim reports Customized ad hoc reports PAGE 8 PAGE 5
Covering Your Business and Your Employees. (continued) Employee Communications It s never been easier for you to give your employees informative, easy-to-understand program materials for your benefits plans. Group Resources provides professional, communication pieces, including: Comprehensive, clearly written Plan Documents and Summary Plan Descriptions Personalized enrollment forms Customized ID cards Payroll stuffers Instructions for claims submissions COBRA, HIPAA, Defined Contribution, HSA & HRA Administration COBRA Administration: Group Resources notifies each terminated employee or dependent, then provides billing and collection for COBRA premiums and forwards all payments to the employer. HIPAA Administration: Without a knowledgeable partner, maintaining compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) can be a daunting challenge. That s why we help you fulfill your continually changing HIPAA obligations, tracking coverages and providing "Certificates of Creditable Coverage." expenses and allow you to offer a high-deductible health plan (HDHP), without exposing employees to massive out-of-pocket expenses. We ll help you determine if one of these is right for you, then we ll administer and monitor the plan and keep you apprised of employee usage and plan performance. Identify and Manage Catastrophic Illnesses With AWAC Just as early detection of catastrophic illness is vital to a claimant s health, it s also critical in managing and containing your plan costs. Our industry-leading AWAC technology is like a defense system that protects your plan assets. AWAC screens per-certification, claims and prescription drug data from our system. Over 66,000 physician-produced algorithms identify at-risk claimants before they become catastrophic. Early detection helps us utilize appropriate resources to assure optimum care at negotiated prices. The personal and professional services of Group Resources makes claims processing much easier and faster than I ever imagined... HSA & HRA Administration: Under certain circumstances, you and your employees might benefit from either an employee-funded health savings account (HSA) or employer-funded health reimbursement arrangement (HRA). These plans give employees a personal stake in controlling health-care PAGE 6 PAGE 7