Whether for small groups or large groups, self-insurance is often a reasonable alternative to a fully-insured employee benefit program. To be successful, plan administrators need an efficient, easy-to-use system, providing timely plan data and quantitative analyses to make quality decisions. The state-of-the-art software solutions from Apex Data Systems deliver this level of quality and support to Third Party Administrators, Associations, Self-Administering Employers, and other entities challenged with handling the full administration and claims responsibilities of a self-funded trust.

No matter how small the organization, to have a strong plan requires a strong system that offers flexibility, accuracy, and full functionality. While also available modularly, the complete systems from Apex Data Systems encompass both administration and claims features delivering a total solution for both professional plan administrators and self-administered groups.

• Ability to support multiple plans and cafeteria selection of benefits at the employee and dependent level.
• Ability to define contributory and non-contributory programs.
• User-definable plans carrying unique data fields regarding funding vehicle, reinsurance carrier, policy number, plan year period, certificate issue flags, and other elements that allow these records to define self-insured, reinsured, and fully-insured products.
• Ability to self-fund by product type or plan code while other coverages are fully-insured, and to have any number of insurance carriers underwrite different contracts, to support the various products offered under an employee benefit program.
• Consolidated billing on a single invoice for health or other self-funded contributions, specific and aggregate premiums, and life insurance or other fully-insured plan premiums.
• Administration fee billing combined with or separate from contributions toward a claim fund.
• Summary Plan Descriptions with ID cards carrying data critical to benefit verification.
• Census data, enrollment information, and the ability for user defined data mining via ad-hoc query.
• Analysis reporting of contributions, premiums, financial figures and data for 5500's.

• Capture of underlying and overlaying plans of benefits for liability of trust versus re-insurer.
• Monthly reports to manage the plan by line of coverage and employee utilization.
• Plan design flexibility to match previously insured benefits or suit the user's unique needs.
• Claims lag reports which detail the time between treatment, the dates claim materials were first received and last received, and the date the claim was paid.
• User defined maximum number of services, maximum benefits, daily allowances, co-pays, coinsurance levels, deductibles and other parameters by type of service or benefit code.
• Provisions for preferred and exclusive provider organizations.
• User-defined cause codes (three-digit alphanumeric field) that let you classify claims activity in a meaningful way, and report on all your claims experience.
• Complete pending and correspondence support.
• Seamless, real-time integration with our administration system so the current eligibility status of each insured is recognized immediately as changes are made.
• Capture of claims information regarding specific and aggregate stop-loss provisions.
• Automatic alerts when the claim reaches user defined reinsurance reporting point and the actual reinsurance attachment point.
• Claim check issuance with provider batch payment feature and check reconciliation.
• Worksheet history for submission to reinsurance carriers.
• Full claims analysis reports including incurred and paid claims, lag studies, reinsurance reporting, and catastrophic losses by incurred, incurred and paid and paid dates.
• Standard and ad-hoc reporting is available to support cash flow analysis and monitor reserves.