Summit believes the primary responsibility of a Third Party Administrator (TPA) is to manage the Plan by effectively coordinating the components and monitoring the financial aspects. This enables the Plan to maintain costs while providing the best benefits to Plan members with truly “Best in Class” vendors.
Summit is an unbundled TPA, meaning Summit does not own, nor is owned by, any other vendor. Instead, Summit maintains strong, effective relationships with many reputable vendors. Summit believes that owning or limiting vendor products under one roof—one-stop shopping—can become the “fox guarding the hen house.”
If there is a preferred Plan vendor, Summit can work with them. Summit can also recommend a Best-in-Class vendor for specific needs. In either case, the integration between Summit and other Plan vendors is seamless in effectively managing employee health benefits programs.
To better understand how self-funding works, you can also review our pages on Self-Funded Health Insurance and Empower Your Benefits: Setting Up a Self-Funded Health Plan.
Summit knows that making a change in health Plan administration can be unsettling. A seamless transition is managed by keeping client contacts informed to ensure that becoming part of Summit’s client family is a positive experience. This is the first tangible example of “Taking Service to the Next Level.”
Summit implements the health program that is right for each client. The goal is to ensure Plan members are informed of the change in administration with applicable Plan materials prior to the effective date of change. Summit prefers on-site meetings with employees to answer questions and deliver Plan materials. For best results, plan on the transition and implementation taking around 45 to 60 calendar days to complete.
Summit’s eligibility team is experienced in designing and developing mapping for complex health Plans that offer coverage for multiple entities, multiple Plan locations, and multiple Plan options. Summit’s Eligibility Analysts maintain changes on a real-time basis upon receipt. Summit will accept enrollment from the client in the manner that is most convenient to the client, including utilization of the web-based enrollment portal.
As the parameters of managing the costs of employee health coverage expand, so does Summit’s ability to coordinate data exchange with other Plan vendors. Summit securely transfers current eligibility and claims data to Plan vendors for disease management, data mining, and to insurance companies for fully insured products.
Summit offers online enrollment with access to eligibility information. Access can be limited to Human Resources or extended to member-level access, at the client’s discretion. Human Resources may also use this tool to perform member searches and claim status review.
Summit will analyze which provider network offers the greatest provider access to Plan members and which network offers the greatest discounts for the Plan’s cost containment.
Summit utilizes an automated system that integrates both billing and eligibility for self-funded and partially self-funded claim processing with fast turnaround times.
Professional Customer Service Representatives assist with any questions pertaining to claims, and online access for Human Resources, employees, and providers is available.
Summit manages receipt and review of claims to verify and determine eligibility for self-funded dental and vision claims adjudication. Summit also has the capability to exchange eligibility with carved-out fully insured dental and vision vendors.
Summit will provide eligibility electronically to fully insured dental and vision vendors upon request.
Summit offers online FSA account inquiry, fund balance review, and the ability to upload receipts. Summit issues debit cards and provides timely reimbursement. Summary reporting and communication materials for on-site enrollment meetings are also part of the Summit Flexible Spending Account services.
Summit partners with various HRA and HSA service vendors that provide online access, debit card issuance, and coordinated account administration to support consumer-directed health strategies.
Summit can customize coverage and administer self-insured Disability benefits, integrating these programs with the employer’s overall health and absence management strategy.
Summit provides complete COBRA Administration services that comply with current regulations—from sending the initial Notice to new hire enrollees to receiving and processing COBRA contributions.
Summit’s Tribal experience began in 1997. Summit currently administers Self-Funded Health, Tribal Liability Programs, and self-funded Workers’ Compensation programs for Tribal organizations for over 100 Tribal Governments and Tribal Entities. Summit has an excellent understanding of Payor of Last Resort under Title 25 and MLR payments under section 506, and maintains a strong respect for Tribal culture, political structure, and sovereignty.
Summit understands and appreciates the unique health and economic issues that face many Tribes today. We recommend and support wellness and disease management programs to help address health issues and advocate using Federal Funds whenever possible to assist with the economic aspects.
Partially or fully self-insured Workers’ Compensation programs are available that take advantage of many of the same benefits of self-insuring health benefits. Summit’s services to improve productivity and reduce costs include, but are not limited to: integrated case management, Short- and Long-Term Disability coverage and management, reduced cost shifting and potential fraud, and access to legal expertise.
Summit is a fully licensed property and casualty broker and claims administrator providing employers’ general liability coverage for fully insured brokerage as well as self-insured claims administration.
Programs can be designed and implemented for Property, Boiler & Machinery, Crime, General Liability, Auto, and Umbrella coverage to support a comprehensive risk management strategy.