You are preparing for a meeting with two business owners,

You are preparing for a meeting with two business owners, Aman and Adib. They jointly own the shares in their company that operates 3 successful Afghan-style restaurants. In total, they employ 37 people including a full-time payroll person, Terri, who is also the Plan Administrator. All employees are covered by an existing group benefits plan that has been with the same carrier for 4 years. The next renewal is 3 ½ month away and the 2 owners have agreed to allow you to review the plan. In a review of the existing plan, you note that there has been an inordinately high number of claims. Which of the following might the high claims level indicate?

a) The waiting periods may be too long.

b) The definitions of a covered event may be too restrictive.

c) The benefit maximums may be too low.

d) The deductibles may be too low and coinsurance factors too high.

 

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