Robert Jones

Most companies have stop loss insurance to protect themselves from catastrophic drug claims. Or they have implemented a drug formulary (Generic, Mandatory Generic, Therapeutic Substitution, Step Therapy Formularies, etc.) to ensure all lines of medication have been attempted before covering the cost of a high priced drug. But what have you implemented within your corporate [...]

What are Biosimilars? As most know, biologics are a medical product whose active drug substance is made by a living organism or derived from a living organism by means of recombinant DNA or controlled gene expression methods.[1]   Biologic drugs have revolutionized the treatment of many diseases including cancer, AIDS and rheumatoid arthritis. Biosimilars are a [...]

Traditionally, benefits in an employee group plan are fully insured. This means that the insurer sets the required premium levels, based on their assessment of the risk and the employer pays the premium. At the end of the policy year, the rates are renewed based on claims experience. Other factors such as the Incurred but [...]

There was a time as benefits consultants where we mostly dealt with management from the Human Resources area of a company. This has changed. We are now often seeing CFOs at the table. Benefits costs are becoming a bigger slice of the pie, bigger line item in the budget, part of the strategic discussions of [...]

              After 15 years of experience, I would say my top 5 tips for employees of benefit plans are: Always, and I mean always, make and keep a copy of the completed claim form and attached receipts before sending to an insurance company for payment. When calling an insurance [...]