Can OML/SCOIC match the current plan of benefits by quoting similar deductibles, co-insurance levels, out-of-pocket maximums, office visit copays, prescription drug coverage, etc.?
OML/SCOIC will present a formal proposal based on an exact duplication of the present benefits in all areas. Benefit processing can change slightly by benefit interpretation but can be corrected.
When are funding factors reviewed?
OML/SCOIC funding factors are review annually based on the experience of each participating employer and the overall experience of SCOIC.
What PPO networks will be used?
OML/SCOIC clients have access to a variety of PPO networks offering the highest level of participation with the deepest discounts.
How often will financial statements be provided to participating employers?
Financial statements are issued 3-4 weeks after month end. These reports assist in forecasting each participating employer’s cost moving forward. Customized reports are available upon request.
Who does the employer/employee turn to when direct service or assistance is needed?
Miller-Lewis Benefit Consultants’ team is available to provide direct full service and support. As the professional advisors to the consortium, they are knowledgeable and have over 30 years’ experience in resolving claims issues, coordination of benefits, prescription drug issues, provider issues, COBRA administration, Human Resources, etc. Normal customer service my be handled by a broker-if you choose.
Are there any up-front fees when joining OML/SCOIC?
No, there are no start up fees for medical COBRA, and/or HIPAA administration associated with the OML/SCOIC proposal. COBRA and HIPAA administration are included in all OML/SCOIC products.
Is the client held responsible for the individual claims over the specific Stop-Loss limit set by the participating member until the claim is filed and paid by the internal pool or Stop-Loss carrier?
Your monthly report will show what is paid out and when the Stop-Loss reimbursement is made to your account on a cash basis but no additional funds will be needed. Your group has a choice of internal pooling limits of $35,000 - $200,000. An OML/SCOIC advisor can assist in selecting the limit best for your group.
How long does the participating member commit to membership in OML/SCOIC?
The beginning is set between the participating member and the SCOIC. After the beginning the membership is set in 3 year commitments.
When a participating member leaves OML/SCOIC, who is responsible for the run-out of claims?
Run-out of claims is funded by the balance within the participating members account. After the run-out period the balance in the account belongs to the participating member. If the account is short of funds the participating member is responsible for the balance needed.