The purpose of this policy is to establish a framework that governs how GroupHEALTH Benefit Solutions (hereinafter “the firm”) handles client inquiries and complaints. The Conflict Resolution Policy is necessary in order for the firm to provide efficient, fair and exceptional service that recognizes, promotes and protects the client’s rights.
This policy shall apply to all employees, officers, directors, representatives, and advisors of GroupHEALTH Benefit Solutions. Clients are encouraged to voice their inquiries or concerns and should expect a response within 30 days of the inquiry or complaint being filed. Each inquiry or complaint shall be addressed with confidentiality, openness and fairness, in a timely and consistent manner. GroupHEALTH Benefit Solutions will do their absolute best to ensure that the inquiry or complaint is resolved to the client’s satisfaction.
Compliance Control Officer
Inquiries and complaints should be first forwarded to the Manager of the department the inquiry or complaint is addressed to or the Relationship Manager for their review. Inquiries and complaints can be forwarded to The firm’s Compliance Control Officer if the client feels their issue has not been resolved to their satisfaction.
Compliance Control Officer contact:
Inquiries are typically requests for information that do not involve a dispute or disagreement between the client and the firm. Complaints are categorized as a dissatisfaction or concern voiced to the firm that relates to the services, performance, policies, or conduct of staff of the firm. A complaint may be made in person, by phone, fax, email, or it may be made in writing.
When GroupHEALTH Benefit Solutions receives an inquiry or complaint, it is assessed to determine the concern, the seriousness of the concern and if there is an immediate answer or solution. Once the initial assessment has been completed, appropriate measures will then be taken to provide a suitable response.
If the question or complaint is not dealt with by the firm but is instead the responsibility of the firm’s service providers, then it is the duty of the firm to direct the client’s issue to the designated person for their review. The firm will follow up with the service provider to verify if the inquiry or complaint was resolved and what was done to resolve the issue. If the inquiry or complaint cannot be immediately dealt with, the firm shall advise the client that more time will be necessary in order to adequately answer their question or concern.
If the complaint is significant, the Manager or Relationship Manager shall bring the issue to the attention of the Compliance Control Officer for their awareness and assessment. The Compliance Control Officer will then notify the insurance company who is providing products to the complainant. The insurance company will receive copies of all correspondence and communications regarding the complaint and will also receive notice when the complaint has been resolved and/or rectified.
All inquiries and complaints must be logged. This enables GroupHEALTH Benefit Solutions to identify consistencies in the inquiries and complaints received, allowing for improvement in service.
If the inquiry or complaint is the result of the firm’s error, an apology will be issued and appropriate measures will be taken to correct the error. If the complaint is not the error of the firm, a detailed explanation of the firm’s decision or the client’s plan policy will be provided.
GroupHEALTH Benefit Solutions strives to deal with inquiries and complaints in a timely matter. In the case of inquiries and complaints that cannot be immediately resolved, clients will receive acknowledgement of their inquiry or complaint within 5 days of the firm receiving it. A full response and explanation can be expected within 30 days.
If the client is not satisfied with the response to their inquiry or complaint, or they are not happy with the quality of service provided, they may contact the Compliance Control Officer for further assistance. GroupHEALTH Benefit Solutions is dedicated to building long and prosperous relationships with their clients. It is GroupHEALTH Benefit Solutions’ goal to provide quality service and to ensure the client is the top priority.