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Self-Funded Benefits Administration

Prodegi is professional third party administrator of employee benefits with the resources and experience to respond to virtually any employee benefit-related need you may have. Whether its helping you with the design and administration of a cost effective group health plan or putting in place a provider network that gives your employees in another state the access they need, we’ll help you find a solution that’s right for your employees and your bottom line. Our services and expertise can help you manage your employee benefit program today and in the future.

Self-Funding  When your employee health benefit plan is self-funded, your company essentially "in-sources" your benefits and takes control of your budget for those services. Prodegi will help you put in place the stop-loss insurance that's necessary to cover claims that exceed actuarially projected claim levels, both on an individual and aggregate group basis. You contribute funds to an account you establish and simply transfer the actual amount that is needed to pay claims and expenses. Excess funds remain in your account and collect investment earnings. There is tremendous flexibility  in the design of self-funded plans. We'll help you design a plan with the levels of coverage, deductibles, co-insurance along with stop-loss protection and cost-containment services that are right for your employees. When conditions demand change, self-funding offers the flexibility to respond. 

Claims Management  In self-funded environment where claims can represent up to 95% of overall plan costs, prompt, professional claim settlement is critical to containing costs. To assure this, our professional claims analysts monitor your plan and adjudicate claims and encounters promptly. Quality service promotes employee confidence and increases the perceived value of your health plan.

Cost Containment
As health care delivery continues to evolve, we continue to implement appropriate cost and utilization management strategies. These programs help our clients find an important balance between cost control and employee satisfaction.

Network Access  We offer access to a broad array of provider networks across the country which will result in savings to you in the form of claim discounts. We then monitor the performance of the provider networks and help our clients determine the real value of promised discounts using our robust reporting technology and decades of claims management experience.

Data Analytics   State-of-the-art information technology is used to provide self-funded employers with timely reports on claims experience, provider practices, funding and more.

Billing   Invoicing, cash management and detailed financial reporting are critical to ensure you know how your benefit dollars are being spent. Information technology enables us to tailor billing procedures to specific client needs, with billing directed to specific locations or divisions within your organization.

Technology and Experience  For both convenience and data security, we offer 24/7 Internet access through a secure web portal for covered employees, employers, brokers and health care providers. More importantly, we support this convenience with experienced customer service representatives and account managers who address important concerns personally. This support provides added peace of mind for plan participants and makes it easier for you to concentrate on your business.

Compliance   By combining regulatory knowledge, administrative expertise and state-of-the-art information technology, we currently help many employers comply with PPACA, COBRA, HIPAA and other regulatory requirements.
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