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For Pooled Groups, Pandemic Stress-Tests Benefits Administration

For Pooled Groups, Pandemic Stress-Tests Benefits Administration
Posted on Tuesday, June 2, 2020 by Janeen Tigges

In the best of times, benefits administration for pooled groups—including trusts and associations—is complex.


These days, that complexity is amplified, and groups need to focus on several specific areas in order to maintain high-quality service as well as the health of the pool.

Maintaining a level or increasing number of lives is vital to pooled groups, where costs and risk are spread across participating employers and their employees. In the corporate world, HR and benefits staff are aware of upcoming furloughs, leaves of absence or terminations. For pooled group administrators, the first knowledge they may have of workforce changes for a participating group is when those changes come through the system.

And, these aren’t normal, small-scale or cyclical adjustments. In the past few months, the US economy has shed a record number of jobs. Earlier this year, we had record unemployment; however, since March millions of people have become unemployed, including many that worked for an employer that belongs to a pool. 

Employees may have been furloughed and will be reactivated at some point. They may have been placed on a leave, some of which have since turned into terminations. Some people had hours reduced. Others were terminated outright. These scenarios have different benefits impacts, including communications, billing and COBRA, which is where the complexity of pooled groups really comes into play.

That’s why it’s never been more important that the fundamentals associated with pooled group administration are functioning effectively and efficiently. This ensures group administrators can continue pool management in the face of potentially significant movement in their pool’s population.

  1. Carrier eligibility files and reporting. With multiple groups in the pool, it’s vital that only those employees on coverage in any given month are included on carrier files, always a potential issue but even more necessary now. This safeguards member groups and the pool from premium for ineligible or uncovered individuals. When there are workforce changes—like furloughs or terminations—the importance of accurate eligibility files and reporting can’t be overstated.
  2. COBRA administration and billing. An estimated 27 million Americans have lost their employer-sponsored healthcare as a result of the pandemic. In addition to the sheer volume of COBRA events, new guidance around election period and payment timing has temporarily made COBRA administration more complicated. Existing processes, including communication and billing, must be adjusted to ensure adherence to the longer and somewhat open-ended election period.
  3. Data reporting. For pooled groups, data is a lifeline. As member groups react to the pandemic with workforce adjustments, having real-time access to analytics that provide insights into the current population can help the pool best manage its health. Both the pool and individual member groups should be able to look at accurate, timely data. This provides not only a foundation for understanding population statistics, it can serve as a check to validate the end-to-end administration.
  4. Communications. The ability to communicate quickly and accurately with member group administrators helps the pool disperse emerging or changing information. These just-in-time messages enable each group to have up-to-date knowledge as the situation evolves with the pandemic. One example is a group adding telemedicine to their healthcare plans. This pool used an integrated administrator communication platform to inform each group about the change. Information is pushed at the same time to everyone who needs it, ensuring consistent messaging within a centralized forum.

At the end of the day, a pooled group needs the continued participation of its members to remain viable and solvent. Attrition or lack of growth can significantly undermine the success of a pooled group, driving up costs and driving down service.

When the headcount within member groups shrinks because of outside economic influences, the pool still needs to maintain a high level of service, accuracy and accountability. In fact, these may be more important than ever in the face of widespread workforce changes. How a pool manages in these tough times may well be a predictor of success in the new normal.

For more information on how technology can help support pooled groups at this time, get our e-book: 6 Ways Benefits Technology Can Buoy Pooled Groups below.