The Heart of Any Benefit Plan: Medical, Dental, Vision Benefits
PBA offers benefit plans with the goal of meeting the cost management strategy to best fit our clients' needs based on employee populations.
Medical Administrative Services
PBA's medical administrative services serve employers who are self-funding their medical benefits programs but want us to take care of all the administrative work for them. We take care of all the operational tasks to save them time and maximize flexibility. Our medical administrative services cover various networks from traditional PPOs to specialty networks that manage specific diseases and conditions.
Preferred Provider Organization Networks
Utilize a network of participating medical providers known as preferred or in-network providers who agree to provide services to plan policyholders at reduced rates. Policyholders can see medical providers outside the PPO's network but at a higher cost.
Contract with transplant facilities to provide access to solid organ and bone marrow/stem cell transplantation while improving cost containment and reducing financial risk.
Narrow & Tiered Networks
Favor selected healthcare providers who have lower healthcare costs or more efficient services to reduce costs without affecting quality measures. Narrow and tiered networks are similar but have distinct differences, but both can be created based on provider performance.
Ancillary Care Networks
Connects policyholders with a wide range of specialized diagnostic services, supportive therapies and support services, such as ambulatory services, durable medical equipment, hearing services, home healthcare, laboratory services, etc. These services complement primary medical care.
Behavioral Health Network
Covers comprehensive behavioral health services for adults, children and families challenged by mental illness, intellectual and developmental disabilities, and substance use disorders.
Employee Assistance Program
A voluntary program in which employees who have personal and/or work-related problems receive free, confidential assessments, short-term counseling, follow-up services and referrals. These programs address a complex array of issues affecting mental and emotional well-being. Services may be provided telephonically or face-to-face.
As healthcare delivery continues to evolve, we have implemented appropriate cost, utilization, and condition management strategies. Patients with chronic conditions get the care they need and clients are better prepared to find a balance between cost control and employee satisfaction. Effective medical management includes:
- Utilization Management
- Case Management
- Condition/Disease Management
We use our experience and expertise to manage the entire Stop-Loss Marketing process for our clients, including negotiating stop-loss insurance terms, pricing, and policy placement. Stop-loss insurance is an insurance policy for self-funded employer plans that provides protection and limits the risk of large claims. We negotiate rates, confirm no gaps in coverage, and tailor optimal stop-loss insurance for our clients to ensure they are protected from any catastrophic losses if their employees' insurance needs become exorbitant due to severe injuries or illnesses.
Dental Administrative Services
Like PBA's Medical Administrative Services, our Dental Administrative Services take care of employers' dental insurance plans and claims, whether they're offered in conjunction with medical plans or as stand-alone options. We work with national PPO network options to increase dental network savings.
Vision Administrative Services
Finally, PBA provides Vision Administrative Services to manage vision benefits plans and claims whether they're offered in conjunction with medical and/or dental plans or as stand-alone options. Our vision plan administration ensures our clients receive the most cost-effective benefits for their employees.