ADVICE TO PAY EXPLAINED

A robust benefits plan is an essential element to retain skilled employees, but with the costs of benefits rising, more and more businesses are looking for cost-effective and innovative solutions to enhance their existing offerings. Organizations with highly effective Short-Term Disability (STD) programs see decreases in their health care costs, overall days absent, claims incidence, and levels of turnover. However, for small and medium businesses in particular, the costs of an insured Short-Term Disability program can be prohibitive. A self-insured program can provide a more cost-effective alternative but requires the support of disability management professionals to maximize effectiveness.

Advice to Pay

Disability Management Institute’s (DMI) Advice to Pay program provides employers with expert support in the adjudication and ongoing claims management of an employee medical absence. Whenever an employee needs to access Short-Term Disability benefits, the company simply notifies DMI, and the claim will be assigned to a dedicated case manager. DMI’s referral process is quick and painless and ensures that both the employer and employees receive the assistance they need, as quickly as possible.

DMI gathers all necessary claim forms details and completes a function-focused analysis that considers information from a wide range of sources including medical information, policy, and other factors unique to an employee that could influence their recovery. Once the analysis is complete, DMI will provide the employer with a recommendation on whether the claim meets the criteria for approval and outline an estimated timeline for recovery and return to work. DMI will continue to proactively follow-up on the claim to facilitate a safe and timely return-to-work and request further information if an extension of benefits may be required.

Prompt communication is crucial for both employers and employees; medical leaves are already stressful and every day of delay results in additional hardship. In 2022, DMI was proud to have an average turnaround time of under 2 business days for an initial claim recommendation, and a return-to-work rate of over 90%.

How does this help you, the employer?

1. COMPREHENSIVE – Short Term Disability adjudication takes into consideration all factors influencing an absence (inclusive of the medical, functional, occupational, non-medical factors and policy provisions)
2. OBJECTIVE – DMI assess claims without bias and in the context of the employer’s absence management/short term disability plan
3. ACCOUNTABLE – DMI understands your business and operational needs with the goal of a safe and sustained return to work
4. CONFIDENCE – having a trusted partner in DMI provides assurance that not only are your employee’s best interest at the forefront, but ensures your needs are being met.

What is the BOTTOM line?

Advice to Pay is a fee-for-service program, either on a case-by-case basis or coordinated on a monthly retainer model (monthly costs are based on previous claims history). Knowing your monthly costs provides stability in your overall absence management planning and budgetary needs.

Beyond the actual cost of the service, DMI is committed to providing a timely and appropriate touch on each file. Efforts are made to minimize duration and actively seek return to work opportunities from the onset of the referral. Emphasis is not only on the medical component but takes into consideration functional abilities in effort to identify modified return to work opportunities. This equates to a shorter duration, of the overall absence, with less impact on your business. A higher return to work rate in the short-term period equates to less claims on Long Term Disability, which means a lesser impact on those premiums.

Lastly, having a proactive and thoughtful provider like DMI overseeing your Advice to Pay program demonstrates to your employees your dedication to health and wellness. Your employees will observe your commitment to supporting them during their time of need and assistance in encouraging them back to work. They will also appreciate the personalized support they receive from their DMI contact and the extra assistance in their recovery and return-to-work.

Disability Management Institute (DMI)

DMI is an independent third party that advocates and supports both the employer and the employee during a disability claim. The services they provide are valuable because they help control the costs associated with disability claims.

One of the most important factors in sustainability is having cost control mechanisms in place. When it comes to cost control for disability benefits, being proactive is the name of the game. At GroupHEALTH, we do this by partnering with the Disability Management Institute (DMI).

Good advice is key

Interested in learning more about how disability management services can help control disability claim costs? Looking for disability benefits that include these services? Review your options with one of our licensed advisors on the phone, or contact us for a comparison quote.

Whether you’re looking for extended health and dental coverage, disability coverage, or life and critical illness coverage, GroupHEALTH has affordable benefit packages that work as hard as you do.