Creating a path to success for every

organization and challenge.

With hundreds of clients in our portfolio, stretching across nearly every industry, we have created practical solutions to help various businesses facing a myriad of challenges.  Drawing upon our long history of crafting benefit packages that deliver results, and with an arsenal of top professional alliances and cutting edge technology and resources to add value, we are uniquely positioned to help clients succeed.

Please take some time to explore a selected group of case studies below and discover how Carmichael Associates can create a path to success for your business.

Problem #1
High Cost of Premiums, HRA

The firm was a startup with the many challenges in a startup situation. Complicating things further, they were unable to pay competitive wages. Therefore, they wanted to give employees generous benefits to offset the low wages. And, they did not have the cash flow to pay expensive premiums. Many of employees were “senior citizens” which results in higher premiums.

Solution

A group HRA with a traditional carrier was used, with a high deductible, which gave the employer a lower premium. (An HRA is a form of a self-funded plan with a limited claims risk.) The employer took the savings from the lower premium and offered the employees a low deductible.

Results

  • A lower cost plan which provides significant premium savings
  • Generous benefits including a low deductible for the employees.
  • Very happy employer and employees.
Problem #2
High Cost of Premiums, Traditional Plan Design
Employees of a prospective client enjoyed the insurance carrier being used to provide their company’s group health insurance. Also, employees had been using their carrier in-network doctors for quite some time and did not want to change. And….the carrier services were good. However the employer’s premiums had been rising substantially and they had just received a huge increase for the new year. In desperation, the employer called Carmichael Associates for help.

Solution

Carmichael designed a unique plan structure for the firm…with the same carrier. This was done using a higher deductible, resulting in a lower premium. However, most medical services and procedures were co-pays on a “before deductible” basis. Therefore patients would not have to be concerned about paying the higher deductible unless they had a major medical issue.

Results

  • Employees were able to keep their doctors and carrier services. Further, employees seldom faced medical issues large enough to incur the deductible.
  • The employer saved significant premium dollars because of the higher deductible.
Problem #3
Backroom Service

The son of the CEO of a prospective client had major physical difficulties from birth. The family was contending with so many issues because of this. There were doctor visits, ER visits, hospital stays, various treatment and therapy sessions. All in all, twelve different providers were being used on a regular basis. This caused serious billing issues with carriers and providers.

Solution

Carmichael brought in their “client manger” system. In this process, a Carmichael staff professional takes charge who has experience with the needs of the client. This requires the staff member to not only be familiar with the particulars of the case but also the treatments, medicines and procedures involved. He/she would then work with all concerned parties to make things run smoothly. The Carmichael staff member must have experience and training in health care and the knowledge of how to work with health industry professionals.

Results

The patient is now on track, the providers are paid the correct amounts and on a timely basis.

Problem #4
Backroom Service
In the birth of a child, the mother wanted to use a method of natural child birth. The process was not an approved procedure and their provider of choice was not in-network. Because of this there was no clear evidence that the patient was going to be covered by the carrier.

Solution

Carmichael utilized a staff member who has specialized in pregnancy and child birth issues. This professional was able to get the procedure in question to be covered by the carrier and was successful in getting the provider to be paid as in-network by the carrier. This required knowledge of whom to contact within the carrier organization and how to communicate the issues.

Results

The procedure was covered and there was one more happy employee of an existing Carmichael client.

Problem #5
Plan Choice

A prospective client wanted to offer a full employee benefits program. Of course, the major cost would be the health plan. Many of the employees had Kaiser HMO for their individual health plan and wanted to keep Kaiser. However, there were others who liked PPOs. Further, some wanted low deductibles, others better co-pays. In general, there was little agreement among employees.

Solution

Carmichael structured a plan design called “base with buy-up” and placed the firm in a private exchange. The employer was able to pay only for the base plan premium. Employees paid for any buy-up plan. (The buy-up plan was generally more costly because it offered greater benefits.) Also, in the private exchange there were many carriers, plans and coverage designs from which to select.

Results

The employees were happy because they could pick what they wanted. The employer was happy because he only paid for the base premium.

Problem #6
Compliance

A mid-sized firm was having difficulties keeping up with government compliance requirements associated with their employee benefits programs. There were so many rules and regs. set by legislation such as ACA, HIPAA, Erisa, etc. Although they were a midsized firm, based on the number of employees working there, their HR staff was limited in size and suffered from turnovers. There was minimal training or experience.

The threat of a government audit by the IRA or DOL was daunting because it could find the company out of compliance. (Penalties from lack of compliance can be extremely large).  They were also worried about a law suit from a disgruntled ex-employee which could have caused compliance deficiencies to be discovered.

Solution

Carmichael introduced its ”Compliance Program” to the prospect firm. In this program, a sister legal firm supplies all documents ensuring these docs. are updated and correct. Carmichael then communicates the required docs to the client firm’s employees using employee email addresses or other contact information. This not only makes the client compliant but it takes the admin work off the shoulders of the employer HR staff.

Results

The firm is compliant. The employees are informed in a timely manner and the HR staff is not overburdened.

The Carmichael Compliance program can make the difference for an employer’s legal and fiduciary responsibilities… and at a minimal cost. The charge is only $300/year.

Problem #7
Cash Bleeding
A firm did not monitor their monthly bills. Several ex-employees who should have been terminated from their plan where not terminated. This had gone on for some time and the costs mounted up. The “cash bleed” had become very serious.

Solution

Carmichael worked with the employer’s carrier to rectify the situation and get credit for the employer for the terminated employees.  This is not easy and requires the understanding of the workings of each carrier. Also, Carmichael worked out with the employer a monitoring system to avoid future “cash bleed”.

Results

The employer was whole again and the system set up between Carmichael and the employer prevented this from happening again.