Strategic Consulting for Employers
Health and Benefits for Businesses and Employers in Puerto Rico
Healthcare costs and benefits decisions can complicate your company's planning. RiskOne Group helps companies and employer groups in Puerto Rico assess their needs, develop benefits programs, and support their implementation.
Overview
An Approach That Begins With the Reality of Your Company and Your Employees
When healthcare costs rise or decisions about your benefits program become more complex, it's not always easy to know what to address first. Explaining alternatives to your employees and providing them with the support they need throughout the year can also be challenging.
At RiskOne Group, we first understand how your benefits work and what your company needs. Then we help you evaluate options, develop a program, or support its implementation.
how we help
How can we help?
Each conversation begins with the size of the organization, its workforce, and the benefits program. It also considers the area that needs attention at that moment.
01
Understanding the needs of the employer and their employees
We review the organization's context, its priorities, and its benefits program. This helps us identify what needs attention first.
02
Develop or Evaluate the Benefits Program
We help evaluate, develop, or implement employee benefits programs. The scope can include group and individual medical, dental, vision, and pharmacy plans.
03
Preparing for Renovation and Market Decisions
We help you compare alternatives and analyze proposals. We also support you in preparing for conversations with insurance companies.
04
Supporting Employees Throughout the Year
Depending on the scope of service contracted, we support coverage guidance, eligibility, claims, reimbursements, pre-authorizations, pharmacy, and benefits communications.
Health and Benefits Areas
Explore Our Health and Benefits Areas
Every organization has different priorities. These are some areas that RiskOne Group can address, depending on the needs of the employer and their workforce.
1. Strategy, Design and Implementation of Benefits
We define or review the structure of the benefits program. We align it with the organization's priorities and available information.
2. Group and Individual Medical Plans
We cater to needs related to group and individual health plans. This page is primarily focused on employers and businesses.
3. Dental, Vision and Pharmacy Benefits
We reviewed dental, vision, and pharmacy benefits. We considered them within the overall program structure and employee experience.
4. Mental Health Programs
We support the consideration of mental health and emotional well-being programs. These can be integrated into education, communication, and benefits planning.
5. Complementary and Specialized Benefits
We can review group living benefits, short- and long-term disability, critical illness, accident, SINOT, and executive benefits. The scope depends on the organization's needs.
6. Renewal Management and Negotiation with Insurance Companies
We support you in preparing for renewals and compare market offers and options. We also help you prepare for conversations with insurance companies.
7. Analysis of Medical and Pharmacy Claims
We analyze medical and pharmacy claims information, when available. This helps identify patterns and questions before making decisions about the program.
8. Education, Communication and Employee Support
We support benefits orientations and internal communications. We also explain topics related to coverage, eligibility, claims, reimbursements, pre-authorizations, and pharmacy.
9. Prevention, Education and Wellbeing Planning
We identify opportunities for prevention, education, and wellness planning. Initiatives depend on available information and employer priorities.
ongoing support
Year-Round Support and Benefit Situations
Benefits needs don't end when a plan is implemented. Throughout the year, employee questions, eligibility changes, claims, or pharmacy issues may arise.
RiskOne Group supports employers with guidance, information organization, and follow-up. The support provided depends on the need and the scope of services contracted. It may include:
- Guidelines on the deck.
- Eligibility questions, registrations, changes and cancellations.
- Support with claims and refunds.
- Questions about medical and pharmacy pre-authorizations.
- Support with pharmacy benefits.
- Communicating benefits to employees.
- Guidance on complex situations inside or outside of Puerto Rico, when applicable.
This support does not include medical advice, claim approval, medication approval, specific quantities, legal representation, or a guaranteed outcome. Its purpose is to provide greater clarity and organization while addressing each individual situation.
Analysis of medical and pharmacy claims information
Identifying questions or patterns that require further attention
Additional guidance to support future program decisions
Situations That May Require Attention
Certain situations may indicate that it is time to evaluate the benefits program and the needs of the workforce.
Before a renewal or a major change to the benefits program.
When health plan costs increase or coverage conditions change.
When the program does not clearly reflect the needs of the employer or their employees.
When a new benefits program is created or one needs to be implemented from scratch.
When the size, composition, or needs of the workforce change.
When employees have recurring questions about coverage, medications, eligibility, or claims.
When there are patterns in medical or pharmacy claims that require further analysis.
When the employer needs to compare proposals or prepare to negotiate with an insurance company.
When there is a need to improve education, communication, or support related to benefits.
How We Address Employer Benefits and Needs
Our process begins with a strategic conversation to understand the organization, its workforce, and the situation that needs attention before evaluating benefit alternatives or defining next steps.
1
Understanding the Organization and its Workforce
We understand the employer's context: its size, workforce, priorities, current programs, and employee needs. This initial conversation helps identify areas that require more attention, and its scope varies depending on the organization.
2
Analyze the Current Situation
We analyze the available information on the benefits program, coverage, proposals, medical and pharmacy claims, and questions from the employer or their employees. The level of detail depends on the available information and the complexity of the organization.
3
Evaluate Options
We evaluate benefit alternatives, coverage structures, insurer proposals, educational opportunities, and other options relevant to the organization. The scope of this evaluation varies depending on the employer's priorities and the service contracted.
4
Support the Next Steps
We assist with implementation, communication, renewal preparation, and year-round support, depending on the organization's needs. Next steps vary depending on the situation and the agreed-upon scope.
Area Contact
Let's talk about your organization's needs.
Share information about your organization to start a conversation about next steps.
Camalis Flores
Health and Benefits Leader
Primary contact for inquiries about benefits programs, medical plans, and year-round support.
Email: vrodriguez@riskonegroup.com
Frequently Asked Questions
Frequently Asked Questions about Health and Benefits
What Does a Health and Benefits Consultation Include?
At RiskOne Group, we help employers with employee benefits programs. Depending on the situation, the scope may include medical, dental, vision, and pharmacy plans, renewals, claims analysis, education, and employee support.
What is the difference between selecting a health plan and having a benefits strategy?
Selecting a health plan addresses a specific coverage need. A benefits strategy begins by understanding the organization, the workforce, and the employer's priorities. It then considers coverage options, costs, communication, and support throughout the year.
What Information Does RiskOne Group Need to Get Started?
RiskOne Group may request general information about the organization, workforce, current coverage, and employee needs. They may also request proposals, renewals, or claims information, when available.
Can RiskOne Group help with group and individual medical plans?
Yes. Depending on the situation and scope of service, RiskOne Group can address needs related to group and individual health plans. The Health and Benefits area maintains its primary focus on employers, employer groups, and decisions regarding employee benefit programs.
How does the analysis of medical and pharmacy claims help?
Analyzing medical and pharmacy claims can help employers understand utilization data. It can also reveal questions or patterns for future discussions. The analysis depends on the information available and does not guarantee savings or clinical outcomes.
How Does Employee Support Work Throughout the Year?
Depending on the scope of service contracted, RiskOne Group can provide support with coverage guidance, eligibility, claims, reimbursements, pre-authorizations, pharmacy, and benefits communications. This support is not a substitute for medical care, the insurer's decision, or legal advice.
Protecting Your Business as One
Evaluate your Benefits Program with More Context
Let's talk about your benefits program, your medical plans, your pharmacy, or your employees' needs. The first step is understanding what your organization needs to develop, evaluate, or address.
