TPA

While many TPAs are no more than “store-fronts” that use outside processing facilities for all their services, others offer a complete range of in-house services, including claims adjudication and payment, securing insurance contracts, and drug card printing and delivery.

When choosing a TPA, employers must ultimately understand which critical services reside in-house, which are contracted, and how those may impact the accuracy, security, and quality of the service they can expect to receive.

The Benefits Trust is a full-service Third Party Administrator.  We help you regain control of your benefits plan and offer the following in-house services:

  •  Daily claims adjudication, payments, and maintenance of employee benefits records
  •  Pay-direct prescription drug cards, electronic dental-claims processing, and direct deposit of employee claim payments
  • Monthly billing statements (by division and department), identifying per-employee costs
  • Formal documentation satisfying legislative requirements for private health-services plans
  • Complete Administration Manual for procedures and forms for notification of employee status changes
  • Monthly financial status reporting, including the current month, year-to-date, and prior year-to-date for on-going monitoring and trend analysis

Ultimately, we help successful business owners build a better benefits plan than they can get anywhere else.

>> Submit the form to immediately receive our complimentary, informative whitepaper entitled, “How to Choose Your TPA.”

 


 
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Eligible Expenses Include:

  • Paramedical Practitioners: such as Physiotherapy & Massage Therapy.
  • Vision Care including Laser Eye Surgery, Contact Lenses, Glasses & Examinations.
  • Medical Facilities including Convalescent Homes & Substance Abuse Facilities.
  • Medical Devices such as Orthotics, Hearing Aids & CPAP machines.
  • Nursing Care to help you recuperate in the comfort of your own home.
  • Expenses Related to Disabilities including special programs tuition, tutoring and home or vehicle modifications.
  • Dental Services Orthodontic & Major Services including Dental Implants.
  • Out of Country Expenses for non-emergency expenses while travelling.
  • Prescription Drugs excluding only over-the-counter medication.
  • PHSP Premiums including any employee-paid premiums for health care or dental care benefits.
  • Private Hospital Room
 

Our Administration Fee is All Inclusive

  • Claims submission by mobile claims app, online claims portal, email, fax, and mail.
  • Daily claims adjudication and payment.Claims will be processed within 1-3 business days, 99% of claims are processed in-house within 24 hours.
  • Claims payments by direct deposit or cheque.
  • Employee and administrator inquiries handled by our client service specialists through telephone, fax and email interaction.A member of the Benefits Trust client service team will answer your call, you will not have to navigate a system to find a human being to speak with.
  • Maintenance of accurate employee benefit records, including Life Insurance beneficiaries.
  • Monthly billing statements (by division and by department as required), identifying benefits costs for each employee in each division.
  • Account changes and billing adjustments carried out by The Benefits Trust.
  • Formal benefits plan documentation to satisfy all legislative requirements concerning private health services plans prepared by The Benefits Trust contract specialists.
  • Complete Administration Manual which clearly outlines procedures and provides forms for notification of employee status changes.
  • Online administration for enrollments, changes, and terminations.
  • Monthly financial status reporting, including the current month, year to date, and prior year to date for on-going monitoring and trend analysis.
  • Employee information meetings at implementation, and regularly as needed.
  • Employee communication materials such as benefits brochures and booklets, announcement memos.
  • Wallet certificate cards provide each member with their contract number and individual certificate number, coordinated with electronic dental.
  • Facilitating insurance claims with the various carriers.