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Third-Party Administration

Your Third-Party Administration Operation

Since Health Risk Services opened our doors in 2000, Third-Party Administration (TPA) has gone hand-in- hand with our Insurance Brokerage. Always focused on industry best practices, we design Plans that meet each of your specific requirements. We then build the matching adjudication system and manage the full claims process for employee Customized Benefits Plans on behalf of employers.

Unlike insurance companies who require a minimum of three to five employees, we have no size minimum or maximum; we create Plans for the self-employed and businesses with one employee or hundreds of employees.

 

Our Third-Party Administration services include, but are not limited to:

  • Design, build and implement desired Plans
  • Claims adjudication
  • Reimbursement of claims
  • Premium administration and billing
  • Benefits Plan documentation inclusive of Booklets and Wallet Cads
  • Maintenance of all records
  • Employee communication

We take pride in our ability to provide clients with innovative benefits solutions including realizing your “ideal” benefits plan.

We strive to “educate” our clients on the various elements and advantages of TPA Plans, what you can expect from your Plan and how we help you achieve your goals and ROI.

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Our Customized Benefits Plans

We Offer:
Private Health Services Plans which have three key design structures to choose from: Cost-Plus Accounts, Health Spending Accounts, and Flexible Spending Accounts.

Self-Funded Benefits Plans which have four key design structures to choose from: Extended Health Plans, Drug Plans, Dental Plans and Short-Term or Weekly Indemnity Plans.

We Administer So You Can Focus on Running Your Business

Having Health Risk manage your TPA Plan lets you focus your energy and expertise where it matters most – leading and running your business.

As your Third-Party Administrator, we:

  • Adjudicate and verify all claims submitted through employer Customized Benefits Plans for eligibility and to ensure compliance with Canada Revenue Agency guidelines.
  •  Process and pay all health and dental claims within two (2) business days.
  •  Direct deposit reimbursements to claimants’ bank accounts.
  •  Provide all necessary claims statements for employees and reporting statements for employers necessary for accounting and tax purposes.
  • Review and manage on monthly basis each client’s Plan to ensure that it’s functioning as desired.
  •  Conduct annual reviews with each client so we can determine the past, present and future success of your Customized Benefits Plan and whether it needs to be “renovated”.