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 the “Best in Class” vendors.
Summit is an “unbundled” TPA; meaning Summit does not own, nor is owned by any other vendor. Instead, Summit is proud to maintain strong, effective relationships with many reputable vendors. Summit believes that to own or limit vendor products under one roof—one-stop shopping—becomes 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” Plan vendor for specific needs. In either case, the integration between Summit and other Plan vendors is seamless in effectively managing employee health benefits programs.
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 the individual client. The goal is to ensure Plan members are informed on the change of administration on the health Plan with applicable Plan materials prior to the effective date of change. Summit prefers on-site meetings with the employees to answer questions and deliver Plan materials. For best results, plan on the transition and implementation to take around 45 to 60 calendar days to complete.
Summit’s eligibility team is experienced in designing and developing mapping for complicated health Plans that offer coverage for multiple entities with multiple Plan locations and 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 perimeters of managing the costs of employee health coverage expands, so does Summit’s ability to effectively coordinate data exchange with other Plan vendors by securely transferring current eligibility and claims data to Plan vendors for disease management, data mining, and insurance companies for fully insured products.
Summit offers on-line enrollment with access to eligibility information. The access can be just for Human Resources, or at member level, at the client’s discretion. Human Resources may also use this tool to do member searches and claim status review.
Summit will analyze which provider network offers the greatest provider access to Plan members and which provider 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/partially self-funded claim processing with fast turn-around times.
Professional Customer Services Representatives assist with any questions pertaining to claims.
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 claims adjudication. Summit has the capability to exchange eligibility with carved out fully insured dental and vision vendors.
Summit will provide eligibility via electronically to fully insured dental and vision vendors upon request.
Summit offers online FSA account inquiry, fund balance and the ability to upload receipts. Summit issues debit cards and timely reimbursement. Summary reporting and communication materials for on-site enrollment meetings are also part of the Summit Flexible Spending Account services.
Summit will partner with various HRA and HSA service vendors with online access and debit card issuance.
Summit can customize coverage and administer self-insured Disability benefits.
Summit provides complete COBRA Administration services that are in compliance with current regulations, from sending the initial Notice to new hire enrollees to receiving and processing of the COBRA contributions.
Summit’s Tribal experience began in 1997; currently administering Self-Funded Health, Liability, and Workers’ Compensation Plans for over 100 Tribal Governments and Tribal Entities. We have an excellent understanding of Payor of Last Resort under Tile 25 and MLR payments under section 506. We have great respect for Tribal culture, its 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 with the 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 cut 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 Legal expertise.
Summit is a fully-licensed property and casualty broker and claims administrator providing employer’s general liability coverage for fully-insured brokerage as well as self-insured claims administration.
Some programs that can be designed and implemented are Property, Boiler & Machinery, Crime, General Liability, Auto and Umbrellas.