Employer Services

Modern flexible solutions for all your health plan needs

WHERE TO BEGIN

MCA can provide your company with an in-depth analysis of your current medical benefit offering. If you are currently self funded MCA can show you how to improve your plan performance, cut costs and gain greater control over your employee medical expenses by:

  • creating financial risk/reward models that let you recapture plan savings year to year

  • eliminating inflated carrier profits from your costs

  • reducing health risks across the population with dynamic population health strategies

  • keeping you in control of your plan designs

  • only taking on the level of risk that is appropriate for your company (reinsurance management)

BUILDING PLANS THAT ARE RIGHT FOR YOU

At the core of all medical benefit coverage is the blueprint or Plan Design. MCA uses the industry’s most sophisticated modeling tools to help design and build comprehensive and cost effective plan designs for your company and this critical process, the foundation for all medical benefit activities, will dramatically affect both a plan’s short term and long term performance. Medical benefit offerings can be industry specific, geographically influenced or economically driven. MCA can help your company tailor a plan that will precisely fit your business’s needs.

Let us make it as easy as 1-2-3...

1

TRADITIONAL PPO MODELS

MCA works with both national and local preferred provider organization to provide the deepest discounts and the most accessible provider coverage in your region

2

HIGH DEDUCTIBLE
PLAN MODELS


MCA can tailor a High Deductible Health Plan (HDHP) Model(s) that can help lower your costs and improve employee benefit satisfaction.

3

LEVEL FUNDING SOLUTIONS

Feel more comfortable with a fixed monthly budget? MCA can help with that too with a cutting edge benefit plan model. Level funded benefit plan solutions provide the freedom of self funding with the budgeting stability of fully insured. Ask your MCA representative how level funding can work for you.

 

Click on services below to learn more

MCA Services

MEDICAL CLAIMS ADMINISTRATION


MCA combines over 40 years of professional claim adjudication expertise with state of the art information technology to ensure benefit claims are timely and accurately paid.




RISK MANAGEMENT/STOP LOSS ADMINISTRATION


Corporate fiduciary responsibility demands that risk be minimized, so MCA works directly with the top reinsurance carriers in the industry to provide our clients with stop-loss coverage at competitive rates.




CLAIM COST CONTAINMENT


MCA has systems to contain costs and improve quality and outcome by identifying high-risk conditions before they escalate into catastrophic illnesses. Furthermore, our system works to spot inaccurately billed claims and helps negotiate costs of care.




FLEXIBLE SPENDING HRA/HSA ADMINISTRATION


MCA is fully equipped to manage diverse plan types including Health Savings Accounts, Health Reimbursement Accounts and Flexible Spending Accounts. These services are available independently or can be integrated through MCA medical benefit administration.




DENTAL/VISION CLAIMS ADMINISTRATION


MCA offers single source administration by providing ancillary benefit management including dental and vision claim adjudication and payment.




REGULATORY COMPLIANCE


MCA offers administrative solutions for COBRA and HIPAA needs. MCA Administrators regulatory compliance services help ensure compliance with HITECH, ERISA, FMLA, TEFRA, and DEFRA.




MEMBER SUPPORT SERVICES


MCA member services division is available to assist members with their everyday questions and needs. Members can obtain information via a dedicated MCA member support representative or electronically through our secure web site.




BENEFIT PLAN DESIGN AND ENGINEERING


MCA custom designs benefit plans for companies based upon the unique history and demographics of their employee population. MCA can help you tailor a benefit plan that protects your corporate fiduciary responsibility while improving the health of your employees.




CARE MANAGEMENT


MCA works with professional care management partners (DM/CM/Precert/Wellness) to help manage the cost of the chronically ill and other high-risk populations. The techniques utilized help prevent condition escalation while improve member wellness and controlling costs.




ENHANCED PLAN REPORTING & ANALYSIS


MCA puts every aspect of plan operation and financial accounting at the employer's fingertips through real time comprehensive analytical reports. MCA reporting helps plan decision makers measure performance and proactively make changes.




PBM & PRESCRIPTION FORMULARY DESIGN


MCA works with multiple nationally recognized Pharmacy Benefit Management companies to match employers with an appropriate Rx benefit partner. MCA Administrators works hand in hand with employers to engineer a prescription drug formulary that enhances plan savings and increases responsible utilization.




NETWORK COORDINATION


MCA works hand-in-hand with networks nationwide to provide the greatest options for member access to quality affordable care.




EMPLOYEE ASSISTANCE PROGRAMS


MCA can assist in building an effective EAP utilizing specialized behavioral health programs including inpatient and outpatient drug treatment programs.




SHORT TERM DISABILITY ADMINISTRATION


MCA provides comprehensive Short Term Disability claim administration services to help ensure FMLA/STD benefits are properly coordinated. MCA uses expert claim assessment, adjudication and management techniques to efficiently and effectively process Short Term Disability claims.





CARE Network Services

PRE-CERTIFICATION/CONCURRENT REVIEW/DISCHARGE PLANNING


Includes:

  • Acute Inpatient Medical/Surgical Hospitalizations
  • Acute Inpatient Rehabilitation
  • Long Term Acute Care (LTAC)
  • Acute Inpatient Psychiatric/Mental Health Treatment
  • Acute Inpatient Chemical Dependency Treatment




CASE MANAGEMENT


Case Management of the Clinically Complex Patient is comprised of:

  • Cohesion of Care
  • Patient/Family Education, Guidance and Support
  • Accessibility of Alternate Care
  • Conservation of Health Care Dollars




OUTPATIENT UTILIZATION REVIEW


Offers:

  • Elective Outpatient Same Day Surgeries (performed outside of a physician's office)
  • Elective Diagnostic Procedures (performed outside of a physician's office)
  • Outpatient Continuing Services (physical/occupational/speech therapy, home health care, etc.)
  • Outpatient Psychiatric/Mental Health/Chemical Dependency Services




MATERNAL NEWBORN PROGRAM


  • Detection and Management of Potential High-Risk Pregnancies
  • Early Maternal Intervention
  • Coordination of Services




POINT OF SERVICE PROGRAM HEALTH MANAGEMENT


Includes:

  • Specialist Referral Management
  • Primary Care Physician/Gatekeeper Support
  • In-Network Steerage




WELLNESS HOPE HEALTH NEWSLETTER


Includes: Monthly Health and Wellness Newsletter Prevention/First Aid/Health Topics





Benefit Planners & Associates Services

SELF-FUNDING GROUP HEALTH CONSULTATION


Large group health plans have much to gain from Benefit Planners and Associates experience designing, implementing and managing partially or fully self-insured healthcare plans. Benefit Planners and Associates works hand-in-hand with MCA to ensure employers realize the maximum value of self-funded benefits.




FULLY INSURED CARRIER QUOTES


Benefit Planners and Associates works with major insurance carriers to provide competitive quotes in order to maximize coverage while keeping costs down.




ANCILLARY GROUP BENEFITS


Benefit Planners offers a single source solution to employer groups by providing a variety of ancillary benefit products including:

  • Dental Coverage
  • Vision Coverage
  • Life Insurance
  • Long Term Disability Short Term Disability
  • Flexible Spending
  • Long Term Care Coverage
Benefit Planners and Associates can help custom design a package that greatly improves your overall employee benefit value.




REINSURANCE


Benefit Planners and Associates works with only the most trusted reinsurance carriers to ensure employers maintain the appropriate levels of risk for their self-funded group health plans. Competitively priced aggregate and specific excess loss coverage is arranged by Benefit Planners and Associates to cap spending and protect the fiduciary check book.




BENEFIT PLAN ENGINEERING AND PLAN MANAGEMENT


Benefit Planners and Associates helps employers manage the duties of administration through an ongoing review of plan performance that includes recommendations for opportunities to improve plan efficiency. Benefit Planners helps maintain the advantages of self-funding by providing continuous oversight of plan performance and monitoring changes in regulatory requirements, allowing us to engineer benefit models that maximize plan performance.





 

PITTSBURGH

1910 Cochran Road

Manor Oak Two Suite 605

Pittsburgh, PA 15220

800-922-4966

KNOXVILLE

2607 Kingston Pike

Suite 190

Knoxville, TN 37919

800-762-8316

HARRISBURG

6345 Flank Drive

Suite 400
Harrisburg, PA 17112

717-652-8040

© 2018 by Managed Care of America, Inc.