Self Funded Medical & Dental
In 1971, Stirling Benefits was founded to help employers take advantage of a "new" concept – partially self-funding employee benefits. Forty years later, the world of health benefits has become more complex, but the same ownership team now guides clients through the complex web of compliance issues, risk management, creative benefit design, and health care reform issues; all the while keeping our focus on exemplary personalized service. For forty years, Stirling Benefits has been committed to serving our clients' needs.
We offer a comprehensive array of services that make your benefits plan a true value to your plan members. We constantly look for new ways to make employees more productive and your plan more cost effective.
Why Consider Stirling Benefits?
| Stirling Benefits | Other TPAs | ASO Carriers | |
|---|---|---|---|
| AWAC Claim Scrubbing, fraud detection and disease state evaluation | X | ? | ? |
| I Pro Cert - Pre certification integrated with claim history | X | ? | ? |
| Stable and continuous ownership for over 40 years | X | ? | ? |
| Managers with over 25 years experience | X | ? | ? |
| Owners served as Chairman of National TPA Association and vender advisory committees | X | ? | ? |
| Annual SAS 70 Audit | X | ? | ? |
| Choice of networks | X | ? | ? |
| Onsite COBRA | X | ? | ? |
| Onsite Compliance | X | ? | ? |
| Onsite Servers | X | ? | ? |
| Onsite Custom programming | X | ? | ? |
| Onsite Customer Service | X | ? | ? |
| No outsourcing overseas | X | ? | ? |
| Onsite Plan documents | X | ? | ? |
| Team leaders with an average of 15 years industry experience | X | ? | ? |
Controlling Cost
There are two notable fallacies associated with health insurance. The first is that employers cannot control their costs. Without adequate data and transparency, it's probably a true statement. If an employer is fully insured, they likely don't know the answers to the following three questions:
- How many times did your employees visit an emergency room last year when they could have just as easily waited a day to see their PCP?
- How many of your diabetic employees are taking their prescriptions regularly?
- How many of your employees are current on their recommended cancer screenings and physicals?
If the employer had the answers to these questions, they could build a program to control the cost drivers. Stirling can help.
The second fallacy is that discounts are everything. There is a myth in the industry that discounts are the single most important factor to lower costs. The logic is that without the steepest discounts, the cost of health insurance will be greater. Comparing the discounts alone is useless as the analysis must also consider the amount of services consumed. It is the combination of unit cost, quality of care, and quantity of care that ultimately determines cost.
The total costs of health insurance are not determined by the cost of the doctor visits; they are driven by the health of the employer's population and the decisions made by the population. Preventing the medical condition that creates a claim is always preferable to simply reducing the cost of the claim.
Access to Data
We have developed solutions for our clients to simplify the process of managing data and obtaining information relevant to their benefit plan. Our eNet™ online system allows authorized users access to a comprehensive plan "dashboard." Groups and consultants have access to enrollment information, aggregated claims data, weekly/monthly reports and benefit information on a real-time basis. eNet™ offers HR and finance professionals immediate access to information that simplifies administrative tasks and improves communication.
Partnership with Industry Leaders
We offer services arguably superior to the largest national carriers by partnering with unique industry leaders that combine the best technologies with personalized care and service. We are Connecticut's only AWAC approved TPA, producing reduced claim costs without sacrificing the quality or breadth of medical services. More on AWAC can be found in our Managing Disease section. We are also specialists with administering Retiree Plans, and we service over 300 separate groups with consumer directed Flexible Spending Accounts and HRA programs. Please click for links to our partner Networks and Prescription Benefit Managers (PBM's).
Simplified Billing
We offer clients the ability to manage enrollment for benefits that may be insured, or with another vendor (life, disability, dental, vision) and offer billing/payment services to simplify the administrative process. Annual "Open-Enrollment" may be conducted using the portal for all benefits the sponsor may offer.
Our goal is to reduce costs and improve productivity over the long term. Our client relationships span decades, not months. Our stop loss partners, Prescription Benefit Managers and other plan vendors similarly seek long term relationships to support our client's goals.
We look forward to working with your team to maximize the value of your benefits.