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Once considered a claim processor, Stirling Benefits has evolved into a specialized risk manager with integrated programs designed to promote individualized behavioral change for improved health. Improved health translates to fewer claims and lower cost. Using the AWAC® disease management software, our physicians identify candidates with chronic conditions or those who would benefit from one of the wellness intervention programs.

Stirling has developed three operational units to serve our clients:

Traditional TPA services
Flexible Benefit Administration
Retiree Administration

Traditional TPA Services

Today, Stirling’s “traditional services” are anything but traditional, offering multiple, state-of-the-art loss control technologies with advanced reporting capabilities to achieve results. Services include:

• Pharmacy management
• Underwriting, risk management and stop-loss administration
• COBRA, HIPAA and regulatory compliance services
• Electronic enrollment, data and reporting services
• Innovative plan designs using wellness incentives
• Claim scrubbing through AWAC®: Every claim is checked against 65,000 clinical algorithms prior to release. Stirling is the only TPA in New England with this advanced AWAC® technology.
• Disease Management: AWAC® scrubbing technology identifies members who are likely to have large future claims. Doctors and nurses then work with the member toward improved health.
• Medical Clinic on site. Stirling can place a doctor and nurse in the employers’ facility.

Flexible Benefit Administration

Stirling began administering Flexible Spending Accounts (FSA) in the early 1980's shortly after passage of Internal Revenue Code Section 125. In 2003 we began issuing debit cards to FSA users and in 2004 became one of the first TPA’s in the country to administer a partially self-funded high-deductible plan with Health Savings Accounts (HSA). We currently have over 100 clients with some form of high-deductible consumer directed account.

One of our most popular products is a Health Reimbursement Arrangement (HRA). This arrangement offers an employer savings through lower fixed premiums with minimal risk. These are suitable for clients that are too small, or prefer not to have a partially self-funded plan, but want to enjoy the savings and flexibility to offer customized deductibles or co-payments. We offer assistance to design, communicate and administer the plan to meet the needs of the business.

Retiree Administration

Stirling Benefits currently administers over 14,000 Medicare primary retiree lives. We receive electronic claims directly from Medicare and adjudicate the retiree plan’s secondary payment. Our proprietary software and data reporting combined with excellent customer service help us compete favorably on service and price with any of the large national insurance carriers.

We assist our clients with Part D administration to ensure the option they select will give them the best dividends. We have the capacity to service retiree clients that have as few as 100 or as many as 5,000 members.

Please call us for additional information. We look forward to serving you.