Progressive Benefit Solutions is one of the very few, and may be the only, consulting and brokerage firm based in the Carolinas that has a full actuary (FSA).  Having an actuary that knows the Carolina market well, and spends each day based in this market, results in more local knowledge and an in-depth perspective on the drivers of Carolina based employers healthcare costs.

In addition, PBS’ national client base ensures that our actuarial knowledge and expertise continues to evolve at the pace of the industry.

It is critical that employers work with a firm that provides local actuarial expertise to independently develop utilization studies, trend estimates, plan decrements, run-out reserve calculations, and an assessment of different funding arrangements.

Utilizing our in-house actuarial resources and expertise on health insurance products, we strategically review claims, utilization, products, and plan designs.  This review is the basis for developing the strategic plan to maximize the value provided to the client and their employees from the healthcare benefits.

For larger employers, our analysis of the claim and utilization data will include costs, trending of claims by quarter and by year, and a projection of claims going forward for each specific product and plan design.  We incorporate the company’s demographics and current plan designs to measure actual experience against expected benchmarks as well as current products and benefit levels against similarly sized and/or similar industry employers. 

One outcome of this analysis will be an assessment by product and plan design of whether any over/underutilization is occurring.  Another will be a determination if the current offerings have an opportunity for improvement or anti-selection based on base benefits, premium rates, out-of-pocket exposure, or packaging of secondary benefits (e.g. vision).

The actuarial analysis will also look at participation rates as well as use of products that can maximize the health care benefits, such as flexible spending accounts, healthcare reimbursement arrangements, or health savings accounts.  We compare this to norms for similarly sized employers and use this benchmark information to determine if there are opportunities for employee education.

We also perform an in-depth review of each and every vendor contract associated with these benefits and use our expertise to identify possible improvements.  We will use our knowledge of other large employers’ contract terms to recommend changes and, if retained, develop the Request for Proposal (RFP) to specifically request these improvements. 

Finally, we review large claims as well as their prognosis and diagnosis.  This not only helps us with our claim projections but also provides appropriate detail if a decision is made to market the stop loss coverage.  We will review the current stop loss arrangement from a product standpoint and do an in-depth analysis on the contact language and terms to ensure the client is getting the best value for their money.

All of our analysis and recommendations are the foundation for our calculation of potential impacts on plan costs and rates due to contract, product or plan changes.  We make an assessment if there is any need for additional products or plan designs for the health benefit program and determine if there are gaps in coverage or additional ways to leverage the group health market and/or the tax code.