Medical Solutions

Benefits Administration

The Boon Group® has an extensive range of capabilities that enable the company to provide high-quality administration for virtually any benefit issue. The Boon Group’s services include:

Benefit Implementation

Full spectrum of benefit implementation, from the preparation of a detailed implementation schedule and the development and distribution of employee enrollment packages to enrollment coordination and the delivery of post-enrollment collateral materials.

Open Enrollment Services

Development and distribution of open enrollment communication materials, conducting open enrollment meetings, collecting and processing enrollment changes.

Account Management Services

Employer concern resolution, plan design and changes, and the coordination and delivery of renewal packages.

Employee Enrollment Assistance

A toll-free customer service benefits help line to assist employees with questions concerning completing enrollment forms, the availability of benefit options in their area, determining plan design or coverage, and changing life status.

Policy Administration

Application screening, processing and issuing plan information including certificate of insurance, schedule of benefits, identification card and HIPAA certificate of creditable coverage.

Premium Billing and Collection

Flexible, proprietary systems that allow for self-reporting by the employer or direct billing. COBRA billing and collection is offered at no additional cost to the employer. The COBRA billing services include monthly billing, collection services and notices of termination of COBRA continuation coverage.

Eligibility Maintenance

Monthly maintenance of plan eligibility using The Boon Group’s proprietary system, including processing of new applications and change requests, reconciling the employer’s monthly report, and transmission of eligibility data to insurance carriers and/or other benefit plan providers.

Claims Administration

Claims adjudication services utilizing a highly automated system that enables 65% of all claims to be auto adjudicated. Claims are processed with an average turn-around time of nine (9) calendar days and an overall accuracy rate of 99%. Boon Administrative Services is HIPAA EDI compliant.

Customer Service

The Boon Group provides a toll-free telephone number for providers and members to verify eligibility and benefits, check status of claims, obtain assistance with policy provisions, etc. Bilingual customer service representatives are available seven days a week, 365 days a year.

Average Cost Accounting

Where the contract allows, fringe dollars can be pooled for all employees working on contracts. Compliance can be determined based on the “average cost” of benefits.

Individual Cost Accounting

For contracts requiring individual cost accounting, the fringe dollars amount will be allocated on an individual basis into the applicable benefit plan(s) for each contract to determine if the fringe obligation is being met for each employee.

Hour Bank Accounting

Hour banks may be used when premium based on a flat monthly rate is divided by the number of hours an employee must work (or be paid for, as applicable) to pay the monthly premium and receive benefits. Any excess fringe dollars attributable to additional hours worked, or paid for, are held in trust and then allocated and accounted for on an individual employee basis. All interest earned on the hour bank funds are also accounted for and added to the balance of funds held for each covered employee on a proportionate basis. Hour bank funds are used to provide benefits when the employee does not otherwise work sufficient hours to fund benefits for the month. By using hour bank accounts the employees do not “fall off benefits” or lose coverage when they have decreased hours due to the seasonality of work or unpaid time off.

Individual Premium Rate Stabilization Account

Individual premium rate stabilization accounts are used when a group is utilizing an hourly driven class level benefit plan design. In such instances the plan sponsor may designate a specified amount of the fringe to be allocated to the individual premium rate stabilization account. These allocated fringe contributions are held in trust and accounted for on an individual employee basis for the benefit of such covered employees. All interest earned on the individual premium rate stabilization funds also is accounted for and added to the balance of funds held for each covered employee on a proportionate basis. If a covered employee does not work sufficient hours to fund insurance premiums for the month’s benefits and the covered employee has sufficient funds held in the individual premium rate stabilization account, such funds shall be used to pay insurance premiums for such covered employee until such time as the funds are inadequate to provide the benefits or the employee again works the minimum number of hours to fund the insurance premiums out of the fringe contributions.

For both the hour bank and the individual premium reserve accounts, in the event that the prevailing rate for fringe contributions under the contract between Employer and the government shall increase during the plan coverage year and prior to the renewal date of the insurance coverage, such additional amounts shall be held and accounted for on an individual employee basis. Additionally, such accounts may also be used to hold funds attributable to premium rebates paid from insurance carriers when the medical loss reserves exceed those allowed by the Affordable Care Act. Such amounts, together with any interest earned thereon, shall be used to provide payment on behalf of the individual covered employees upon whose behalf such funds are held, together with any interest earned thereon, of any amounts that are attributable to premium rate increases after the renewal date of the insurance coverage.

Sick Leave Accounting

A sick leave fund is established when a company wants to pre-fund paid sick leave accounts and take credit for the sick leave against the designated fringe rate.

Allocation to Multiple Benefit Plans (Audit Trail Accounting)

Fringe benefit dollars can be allocated to multiple “bona fide” benefit plans. Contractors will receive detailed reports showing each of the allocations.

Additional Items of Benefits Administration

  • Transmit monthly eligibility data to plan providers
  • Issue summary plan descriptions and plan documents for self-funded plans