Employee Benefits Programs

Our solution is to find a balance between the optimal cost of the program and the level of coverage while improving service levels to employees, thus reducing the volatility a sustainable plan can have in the future.

Through the development of a comprehensive diagnostic, we conduct a full analysis focused on claims and administrative handling, program costs, coverages and service levels. As a result, a specific strategy is developed towards achieving strategic objectives, such as cost containment, minimizing the impact on hired coverage and administrative insurance related tasks, in a multi-year analysis, and with benchmarks or insurance markets frameworks.

Some aspects of our analysis of Employee Benefits Programs are:

    • Have you had premium increases above inflation? Above medical inflation? Above general increase in payroll?
    • Does the net premium stand in reasonable parameters vs. the annual payroll?
    • How has the program premium vs. inflation evolved?
    • Is the average per capita net premium within reasonable parameters?
    • In the case of “Group Life Insurance”, does the policy have a profit sharing mechanism installed? Is this mechanism legal according to the Mexican Insurance Laws and optimal?

    • Impact on the accident rate of the following variables:
    • Turnover levels
    • Socioeconomic levels
    • Rate of dependents per main insured and multi-year projections
    • Income levels
    • Population geographical location
    • Ages and gender (population pyramid)
    • Level of use of the policy in frequency and average cost
    • Insured staff size expectations

    • Impact on the accident rate of the variables:
    • Are there policy holders with contributory participation?

    • Are there retired policy holders?

    • Is there coverage for former employees?

    • Are the economic dependents covered? Under what rule?

    • Are all employees insured, or only a subgroup or section?

    • Is there medical and hospital infrastructure within the region where the policy holders are located?
    • Does the current insurer have good hospital agreements and an acceptable network?
      Is the direct payment usage within reasonable levels? Is the network being used?
    • In case of out-of-network use, is the medical fee tab suitable for each insured subgroup?

    • Is it well designed according to the socio-demographic and social needs of each subgroup within the insured population?
    • Does it cover individual insurance cover conversion?
    • Are the deductible and coinsurance, tabulation, hospital level and coverage with sub-limits such as maternity, nose & vision medical claims, aligned to the insured population level of income?
    • Is there policy overutilization or underutilization?
    • Do you have additional coverage such as vision, dental or minor medical expenses?
    • Do you have optional coverages?
    • About life insurance, is the level of insured sums and coverages competitive?

We have a consultancy-oriented technical area oriented to consultancy with the best negotiation capabilities. We develop a specific decision-making matrix that allows immediate simulations of your program cost by varying its critical variables. Our matrix can also execute medium term projections, considering population aging models and the future behavior of policy holders and other environmental factors.

  • We define detailed and personalized service level agreements, by adapting to the corporate philosophy of our customers, identifying the specific servicing needs and with the best medical management area in the market supported by our unique technological platform, operating 24/7.