Please click here to view your strategic calendar: Fisher Associates Strategic Initiatives

Lawley Benefits Group is a division of Lawley Service Inc., one of the largest independent insurance brokers in the Northeast. Lawley began operations in 1955, employs 400+ professionals, and specializes in employee benefits, business insurance, workers compensation, risk management, surety bonds, personal and specialty insurance.

Operational since January 2000, Lawley Benefits Group is comprised of 100+ professionals dedicated to employee benefits consulting. Lawley Benefits Group is managed by six owner-partners with extensive industry knowledge and experience in all aspects of employee benefits consulting. In a highly evolving industry, our firm is distinguished by its philosophy, approach, process, and commitment.

Our firm’s core services are centered on all aspects of employee benefits broker and consulting services.
Lawley will offer multiple solutions, expertise, strong service support, and an array of resources to Fisher Associates. Following is a highlight of our services:

Areas of Expertise

• Strategic Benefits Assessment and Planning
• Custom Plan Design
• Funding Arrangements and Strategies
• Underwriting and Financial Analyses
• Specialty/Custom Reporting
• Benchmarking and Industry Trends
• Compliance and Legislative Services
• Wellness Consulting and Programming
• Plan Implementation
• Online Enrollment and Benefits Administration
• Consortiums, Trusts, and Multi-Employer Plans
• Prescription Benefits Consulting
• Medicare Services
• Cost-Control Initiatives

Products and Services

• Medical and Prescription Drug Plans
• Dental, Vision, Life and AD&D
• Short-Term and Long-Term Disability
• New York State Disability (DBL)
• Voluntary Benefits
• Executive Benefits
• Retirement Plans
• Senior and Individual Health Insurance
• Claims and Financial Analyses
• Utilization Trends
• Contribution Strategies
• Compliance Services and Legislative Updates
• Employee Engagement Services
• Lawley Marketplace Benefits Exchange
• Lawley PowerConnect Benefits Administration Platform
• Lawley Proactive Health Medical Captive
• Cafeteria Plan Design and Implementation
• COBRA Services
• Form 5500 Preparation
• Billing Consolidation
• Communication Campaigns

Our firm designed its account services unit to support the needs of our clients. We formed a collaborative and team-oriented structure that services clients by market segment. Segmentation allows each account team to work with clients who face similar issues. Your account team is comprised of skilled and experienced benefit professionals who work with employers of similar size and complexity. They are the point of accountability on all service issues and inquiries.

Lawley Benefits Group goes above and beyond to help resolve administrative issues with a positive resolution. Your dedicated account executive will work directly with you on both employer based and employee based issues, including open enrollment, annual renewals, carrier communication, plan implementation, and day-to-day servicing.

Typically, if there is an issue escalation, your account executive will work with the carrier or administrator on your behalf and communicate issues to the account team. With established long-term relationships with local and national carriers, our firm has access to senior leadership if needed. Please see the step-by-step walk through of our process below.

Your account executive will provide you with a plan of action and obtain feedback to ensure the plan meets your needs in resolving a situation. The issue will be escalated to senior leadership of our firm and the carrier if it is not resolved. Once the plan of action has been completed, the account executive will follow up with you to confirm your complete satisfaction.

What happens when an employee contacts Lawley for a denied claim?

1. Employee calls or emails Tom Costanzo, Account Executive.
2. Tom gains an understanding of the situation by asking questions (i.e. was it a preventive visit? did they find something during the preventive visit? did the employee reach the out-of-pocket maximum for services, was it out of network?)
3. Tom asks the employee to send supporting documentation (i.e. medical bills, Explanation of Benefits, denial from insurance carrier).
4. Tom uses our CRM system, Sales Force, to see how the claim interacts with insurance plan (i.e. is it a covered procedure?).If it can’t be resolved after reviewing medical bills, EOB and benefit summary, Tom will ask the employee to complete a HIPAA authorization form which gives him the ability to talk to the carrier/medical provider on his/her behalf as it relates to this specific claim.
5. Based on information provided, Lawley will then advise the employee if we agree with denial or if the employee should appeal the decision with the insurance carrier.
6. As part of the appeal process, Tom will request a peer to peer review of the denied claim (provider calls the medical director at the insurance company so the medical provider can provide the facts and medical reasons why the employee/dependent needs the procedure).
7. If the claim is denied again, the employee will need to file an appeal with NYS, and Lawley will assist the employee with this process.

What if an employee contacts Lawley for assistance with a bill?

1. Employee calls Tom Costanzo, Account Executive.
2. Tom gains an understanding of the situation by asking questions (i.e. was it a preventive visit? did they find something during the preventive visit? did they visit an out-of-network provider?)
3. Tom asks the employee to send any supporting documentation (i.e. medical bills, Explanation of Benefits, correspondence from the carrier).
4. Tom uses our CRM system, Sales Force, to see how the claim interacts with the medical plan
5. If it appears there has been a coding error, Lawley will call the provider to request that they rebill insurance with the proper code.
6. After Tom has discussed the situation with the insurance carrier/medical provider, Tom will call the employee to explain how the issue was resolved.
7. Tom will provide the employee with information on how to read future bills from the carrier which shows what each term means ( i.e. billed amount, allowed amount, amount applied to deductible).
8. Lawley will compile the information to include it in our open enrollment meetings and employee education materials.

What if an employee contacts Lawley for assistance with a coverage question?

1. Employee calls Tom Costanzo, Account Executive, with a specific question and Tom uses Sales Force which shows the employee coverage details (i.e. deductible information, examples of preventive services).
2. Tom will send educational materials (i.e. how does a deductible work? what is an FSA, HRA, HSA? what is an embedded deductible?).
3. Lawley has created a virtual enrollment center that will include, but is not limited to an open enrollment presentation with voice overs so employees can watch at their convenience and review sections that are applicable to their specific situation.
4. Lawley tracks employee contacts within Sales Force so we can spend more time on relevant topics during open enrollment.

View a sample of our Renewal Binder, similar to what you would see as a client: Sample 2020 Renewal Binder
In the next few months, we will also be rolling out our “Virtual Enrollment Center” that creates a digital and mobile environment for your associates to walk through their benefits options, navigate resources, and work with the Lawley team one-on-one or in a group setting via Zoom.

Approach and Process
The key to our approach is analyzing your data; it will help determine a specific strategy for Fisher Associates. Your Lawley team will perform an in-depth assessment, analyze your data, formulate a specific plan, implement initiatives, and leverage our relationships and experience to make informed decisions and develop the best possible program for Fisher Associates.

In addition, our firm will complete the analytics to initiate our ‘blueprint’ process by conducting the following:

• Evaluating current practices to purchase health insurance, group insurance benefits, third-party administration services and all other benefits provided by your organization.
• Assess and establish procedures to manage employee and retiree eligibility.
• Lawley will provide a comprehensive plan to help minimize rising costs for insurance and services related to employee benefits.
• Lawley will work closely with vendors and identify trends which are driving costs and recommend alternative strategies for control.
• Lawley will analyze current contracts with vendors and prepare a recommendation and timeline for the re-bidding of existing contracts including providers of insurance and administrative services.
• Lawley will assist in negotiations with vendors to ensure the services and costs are of the highest standards with the best possible price. Our services will include assisting as needed with the preparation of the request for proposal and the analysis of the response.
• Lawley’s on-staff compliance specialist will analyze and develop communications and procedures to ensure your organization is meeting all state and federal health care reform mandates.
• Lawley will assist the benefits staff in developing a business plan with specific goals to improve the management of its various programs.

Your Lawley team will conduct a comprehensive assessment and develop a timeline with strategic initiatives based on your goals and objectives. This allows us to provide your organization with a customized plan that includes enhanced services to improve efficiency, effectiveness and help reduce costs. The timeline is shared with you and your Lawley team will meet with you regularly to discuss details, issues, and progress.

Extensive Resources
With more than 100 dedicated to employee benefits, our scale affords us significant leverage with insurance companies and extensive resources to help you manage your benefits, including:

• Underwriting Team
• Compliance Team
• Technology Solutions Team
• Wellness Team
• Prescription Benefits Consulting Team
• Senior and Individual Health Insurance Team
• Human Resource Partners and Online Tools

Evaluation and Selection of Vendors/Carriers
Lawley Benefits Group holds the marketplace, insurers, TPAs, and PBMs accountable for the delivery of contracted services with an emphasis on proactively managing our clients’ health insurance checkbook. We focus on evaluating and negotiating with insurers and administrators on behalf of our clients, and we employ thorough selection criteria and performance objectives when considering a vendor.

Our firm will focus on areas that will have the most impact on meeting your goals and objectives. The main criteria will be based on established priorities determined in our strategic planning meetings. If needed, our firm will manage a request for proposal process. Our firm compiles the responses, creates a summary, and develops a scorecard based on your outlined criteria. Lawley manages a structured implementation process and will work closely with your organization to ensure the vendor and/or carrier meets your needs.

Annual Renewals
Your Lawley team will prepare for your renewal several months prior to open enrollment. The renewal process starts with reviewing vital information with our clients – budget, industry changes, contract requirements, claims experience, utilization trends, participation, employee cost sharing, marketplace trends, and more. In addition, we share the latest benefit trends and review plan reporting to help evaluate the current benefits program and make informed decisions.

Our underwriting and financial analysis team focuses on an independent verification of your premium rates. Your Lawley team will provide this information to you months prior to your renewal in order for you to begin your planning process. Upon renewal, we re-examine your data; this is the starting point for our negotiations. Our firm’s familiarity with the local carriers’ underwriting practices has proven to be pivotal in dissecting the rates and allowing Lawley to negotiate successfully.

Our firm conducts a thorough plan analyses, funding analyses, and cost comparisons to provide alternatives and recommendations. Lawley will help determine if plan design changes or additions are needed and if a request for proposal to carriers, third party administrators or vendors is required for the upcoming renewal. Our firm will manage the process and customize the request for proposal to the right carriers, third party administrators, and/or vendors for your organization. An analysis of the responses will be provided, and our firm will negotiate directly with the carriers on your behalf.

Employers are tired of the rising cost of health insurance.

HR directors and managers want benefits and programs that appeal to new talent. CFO’s are looking for ways to protect their bottom line. Lawley Proactive Health is a solution for all of these issues. As an exclusive member-based health captive, employers in the group are able to take control of their own destiny, help the wellness and productivity of their employees, and, best of all, save actual dollars on health insurance (our members have received over $3,000,000 in dividends over the history of Lawley Proactive Health.)

What is a health captive? Captives can be confusing. That’s why we asked George Huyler to explain what a health insurance captive is. ConServe, George’s organization, is a current member of Lawley’s health insurance captive — Lawley Proactive Health.