Insurance Companies
Insurance companies, also known as insurance carriers, provide financial backing and offer administration services for insurance plans. They underwrite various types of employee benefit plans, such as health, dental, disability and life insurance. Carriers are crucial in designing benefits packages, assessing risk, setting premiums and paying out claims.
Reinsurers and Stop-loss Carriers
Reinsurers and stop-loss carriers are related to carriers, as they also provide risk transfer and financial protection services. Reinsurers provide insurance to other insurance companies by insuring the risks taken on by primary insurers in exchange for a portion of the premiums collected, whereas stop-loss carriers provide coverage to self-funded employers and health plans to protect against large and unexpected claims. Many of the same carriers that offer stop-loss insurance also offer common group health care plans.
Employee Benefits Brokers
Brokers are vital in enabling employers to offer competitive benefits packages tailored to their employees’ needs and budgets. Brokers act as an intermediary between organizations offering employee benefits and insurance carriers, helping their clients find the right insurance coverage for their specific circumstances. They provide expert advice, help clients assess their needs and manage policy administration.
General Agents
General agents (or GAs) are individuals who work with insurance carriers and sell insurance products to other insurance agents or brokers. They provide consulting services, conduct market analyses, negotiate pricing and terms with carriers, and assist with plan implementation and ongoing support.
Third-Party Administrators
Third-party administrators (TPAs), handle the administrative tasks associated with employee benefit plans on behalf of many employers. These tasks may include claims processing, enrollment management, compliance with regulations and employee customer support. TPAs offer expertise and efficiency in managing benefit plans, allowing employers to focus on their core business operations.
Administrative Services Organizations
Employers may choose to work with an administrative services organization (or ASO) that provides administrative and HR services. This is a simple way to outsource and bundle tasks that can be more efficiently handled outside the company—such as payroll, HR and employee benefits. An ASO may handle benefits enrollment, payment and premiums, Consolidated Omnibus Budget Reconciliation Act administration and more.
Pharmacy Benefit Managers
For most health plans, the pharmacy benefit manager (PBM) is the central figure in designing and administering the plan’s prescription drug benefits. PBM responsibilities include negotiating with drug manufacturers and pharmacies, developing formularies and processing prescription claims.
