1-800-750-0490

956-423-0490


521 South 77 Sunshine Strip Harlingen, TX, 78550

Services

GROUP HEALTH & ANCILLARY PRODUCTS SERVICE GUIDELINES

For the employer
  1. Negotiate new business pricing and benefits on fully funded or self funded programs with well known carriers such as Blue Cross Blue Shield, Aetna, Humana, and Allstate.
  2. Act as a liaison with the in-force carrier to negotiate pricing and benefits for the plan renewal by analyzing claims experience and other pertinent factors that affect pricing. Ascertain that current costs are competitive by requesting bids from other carriers, if applicable..
  3. Coordinate and conduct any and all enrollment meetings.
  4. Assist benefits coordinator/HR department with weekly new hire orientations and quarterly employee orientations.
  5. Conduct continuous review of the group's experience and present ongoing reports to designated personnel. Take appropriate steps to maintain the most cost effective plan for the company.
  6. Maintain a close working relationship with designated individual from the Insured's entity on claims issues.
  7. Monitor large ongoing claims and insure that any stop loss claim is paid by Stop Loss carrier and not the insured's entity.
  8. Assure that the claim processing is expeditious and accurate.
  9. Keep you abreast of any issues or potential problems with claims that are not covered due to exclusions in your benefit package, (i.e) pre-existing condition, and educate members with payment expectations.
  10. Conduct regular servicing education (Q&A) meetings as determined by staff.
For the employee
  1. Provide a toll free number, 1-800-750-0490, and easily accessible bilingual staff for any questions the insured may have on claims and/ or coverage.
  2. Help with completing claim forms and filing claims. (Bilingual Staff)
  3. Explain to claimants how claims are processed and the amounts due by the employee to providers so they are aware of the amount the carrier will pay and what they are responsible for. It is difficult enough to have to worry about being ill, let alone worry about the cost.
  4. Conduct seminars at the beginning of each year to familiarize the present and new employees with the benefits you provide and answer questions. (Available in English and Spanish.)
  5. Availability of a service person at your location to help your employees with forms or to answer questions at your discretion.

PROPERTY & CASUALTY SERVICE GUIDELINES

For the employer
  1. Prior to an insurance policy's expiration date, the Agency will meet with the Client to discuss the requirements and to develop a plan for the renewal process to include reviewing of the following:
    • Buildings & Contents Schedule
    • Automobile Schedule
    • Musical Instrument Schedule
    • Radio Schedule
    • Computer Schedule
    • Contractor Equipment Schedule ie., Tractors, etc.
    • Audio/Visual and Camera Equipment Schedule
    • Boiler & Machinery Schedule
    • Worker's Compensation Payrolls
    • Liability Exposure
    • School Board Legal Exposures
    • Crime Exposures
    • Bonding Needs
    • Other items which may be deemed necessary
  2. Agency will use its best effort to cause the prompt and timely receipt of insurance quotations and proposals and will prepare a comparative analysis of all quotations and proposals submitted for delivery to the Client no later than 60 days prior to the policy renewal date.
  3. After the Client's directions to place the insurance coverage, the Agency will provide the Client the insurance policy and related documents. Upon receipt of the insurance policy, the Agency will analyze it to determine compliance with the coverage proposed to and accepted by the Client.
  4. Agency will prepare an analytical summary for each insurance contract it procures on behalf of Client
  5. Agency will assist, as requested, in claims inquiries, follow-ups, negotiations, claims settlements and will act as an advocate of the insured(s) in all dealings with the insurance companies.
  6. Upon request of the Client, the Agency will review Client's business contracts and agreements to determine Client's insurance requirements and risk management issues.
  7. Upon request of the Client, the Agency will review Client's business contracts and agreements to determine Client's insurance requirements and risk management issues.
  8. The agency will meet with the client to discuss any insurance related matters. Furthermore, the Agency will participate in all other meetings deemed necessary by the Client, upon reasonable notice but no later than forty eight hours before any meeting.
  9. Agency agrees to comply with local policies and state and federal laws in providing his services to the Client. Specifically the Agency will assure that he will comply with all rules, policies, and laws relating to the purchase of insurance by Client.