FAQ

Have additional questions?
Reach out to us by calling (417) 782-1515 or emailing us at benefits@gotobmi.com.

Brokers

I'm new to self-funding, can BMI help me better understand how self-funding works and why it might be a good option for my clients?

Yes - we believe in the value that self-funding brings to clients and are always eager to help our broker partners be in the best position to offer their clients solutions that will work for them over the long-term. If you're new to self-funding you can reach out directly to our President, David Powell, who will personally help you get the information you need. You can reach him via email at david@gotobmi.com.

Why choose BMI over other TPAs?

We're constantly evolving to meet the needs of our clients. Our localized expertise, in-house offerings, and excellent customer service help drive strong value resulting in high client retention.

Can BMI support me in renewal discussions with clients?

Yes - we know self-funding can be confusing, especially for first-time clients. We're here to help educate clients and co-sell with brokers as requested.

Does BMI work with brokers to deliver self-funded healthcare options to employers?

Yes- BMI feels strongly in offering design and administration of self-funded healthcare plans together with a client's broker.

How can I get in touch with BMI?

If you're new to BMI and the services we offer to clients who are self-funded or are considering self-funding, we'd love to connect to share what makes us unique among other TPAs. You can either reach out via our customer service team or directly to our President, David Powell, via email david@gotobmi.com.

Employers

I hear self-funding doesn’t work for companies with fewer than 250 employees?

Big and small businesses alike gain several advantages through self-funding, including money-saving benefits and greater flexibility. Smaller businesses are more concerned about catastrophic claims, but purchasing stop-loss insurance protects you. Self funding began in the 1950's.  Development of stop loss products made self funding feasible for employers with 15 or more employees.

What happens to my company’s health claims data?

You own it, so it’s yours. You’ll have full access to claims data, which allows you to make targeted decisions that can improve your employees’ healthcare and control costs.

What are other advantages to a self-funded health plan?

Fully insured plans offered by health insurance companies can be inflexible with no changes allowed. With a self-funded health plan administered by Benefit Management Consultants, LLC, you’ll have the freedom to choose copay amounts, deductible amounts, and covered services.

How do I know how much money to set aside? And what about the risk involved?

Working with Benefit Management Consultants, LLC, you’ll be able to determine the level of coverage you require and the budget to fund it.  You’ll purchase stop-loss insurance to cover unanticipated high claims costs at the individual and/or aggregate level.

Where do the costs savings come in?

Self-funded plans reduce your premium costs. Self-funded plans are also preempted by ERISA from paying state mandated costs. Most important: You pay only for the healthcare services your employees actually use, rather than a fixed monthly premium. If eligible medical claims for a year do not exceed your plan’s predetermined limit, the plan can keep those dollars to offset the subsequent year’s funding.  What is normally profit to an insurance company goes to the bottom line for a self funded employer.

How do self-funded health plans work?

A self-insured health plan is one in which your company assumes responsibility for providing healthcare benefits to your employees. A self-funded plan is not health insurance in the sense that you pay premiums to a commercial insurance carrier and they administer the plan. Instead, your company sets up a fund for your employees’ healthcare claims and hires a third party administrator (TPA) like Benefit Management Consultants, LLC. to administer it.

Why should my company self-fund?

As healthcare costs can be managed like most operating expenses, employers are increasingly looking to self-fund their employee healthcare benefits. They’re tired of one-size-fits-all insurance policies, annual rate increase and are seeking more flexible, cost-effective alternatives.

Members

Who should I call if I have a question on my claims?

We know claims can be confusing, which is why our customer service team is on call to help you get the answers you need.

You have a right to question and/or appeal the processing of a claim. To receive an explanation of how your claim was processed, you may use the 'Online Customer Service' section of your healthcare portal, contact the BMI customer service team by phone, or email your inquiry to benefits@gotobmi.com.

Who is eligible to add to my plan?

a) An Employee's spouse, unless separated or divorced;

b) An Employee's children from birth up to age 26, including natural children, legally adopted children, stepchildren, children for whom the Employee or legal spouse have been granted legal custody, and children placed in the Employee's physical custody for the purpose of adoption.

What is pre-certification for inpatient hospital care?

Pre-certification is a part of the utilization review process; it is designed to ensure that patients receive quality care that is medically necessary and appropriate to their condition. BMI must be contacted prior to a non-emergency admission. If you are admitted to the hospital on an emergency basis, you have up to 48 hours after admission to make the notification. The appropriate phone number can be found on the front of your ID card.

What is a Prescription Benefit Manager (PBM)?

More commonly known as your prescription drug vendor, a PBM contracts with independent pharmacies or a chain of pharmacies to provide prescription medicines at a discounted rate for retail and mail order prescription drug programs. Your PBM name and phone number is located on your ID card.

What is a preferred provider, and how does using one affect my benefits?

Since changes in network participation can occur, it is important to verify that your health care provider is a current participant prior to receiving medical services. Verification can be obtained by contacting the network directly or reaching out to BMI's customer service team at benefits@gotobmi.com.

How can my provider request a copy of my eligibility and benefit information?

Providers can obtain eligibility and benefit information directly from BMI’s healthcare portal once they have signed up for access to patient information. You or your provider can also request this information by calling our customer service team.

What if I have expenses for an accident or illness that may be payable by worker’s compensation insurance, car insurance, or another third party?

Your health plan may have a right to recover payment made on your medical bills if they were incurred for an injury or condition caused by another party. This right falls under the subrogation and reimbursement provision of your coverage. If we pay benefits as a result of an injury or illness that was caused by another party, we have the right on behalf of the plan to proceed against the party responsible for your injury or illness to recover the benefits the plan has paid. Under certain circumstances, the plan may also be entitled to be reimbursed for the benefits it has paid from a settlement or a judgment you receive from the party responsible for your illness or injury.

Mail can be sent to BMI directly at the address below:

Benefit Management, Inc.
P.O. Box 3001
Joplin, MO 64803

BMI's fax number is 417-782-2777. When faxing information to BMI, please retain a copy of the fax machine’s confirmation record, which shows the date, time and phone number you faxed the information from. Our customer service team will need this information if you call later to confirm receipt.

If my pharmacist has a problem processing my prescription, what should I do?

First, ask your pharmacist to contact the pharmacy help desk at the number listed on the front of your ID card to find a solution to the problem. If your pharmacist will not make the call, contact the pharmacy help desk directly.

The pharmacy help desk phone number contacts your Pharmacy Benefit Manager (PBM). If your PBM indicates that the prescription is not covered, you may be required to seek pre-approval. If so, ask your doctor to send a letter of medical necessity to BMI:

Attn: Medical Review Dept., P.O. Box 3001, Joplin, MO 64803.

I received an Explanation of Benefits form; when will my provider be paid?

The law governing self-insured employer groups requires BMI to send you a claim determination notice within 30 days of receiving your claim for benefits. We mail provider payments and Explanations of Benefits (EOB) at the same time. If payment has still not been received by the provider, please call our customer service team at 417-782-1515.

How long will it take to receive my ID card?

Once your enrollment form has been completed and submitted to BMI, you should receive your ID card within 7-10 business days. If you need your coverage information prior to receiving your card, can contact BMI for a temporary card by calling 417-782-1515 to speak with a member of our customer service team.

Do I need to file a claim?

Normally your healthcare provider will file a claim on your behalf. The appropriate mailing address is indicated on the back of your ID card, which should always be shown to your provider at the time of service. Your provider will then submit the required information to us on a standard form for processing.

How do I add someone to my policy?

You can add a dependent to your policy during the annual enrollment period or within a number of days of a qualifying life event, as outlined in your plan booklet. You can verify your coverage information in the eligibility section of your plan booklet.

If you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be able to enroll the dependent for coverage provided the request for enrollment is received within the number of days specified in your plan booklet. To submit a change to your enrollment in coverage, follow the process outlined by your human resources team. As you have questions on enrollment, you may also reach out to our customer service team.

How can I verify claims paid for members on my healthcare plan?

Sign into the healthcare portal and use the 'My Claims' link. You can also contact our customer service team for assistance.

How can I obtain a copy of my ID card?

Sign into your healthcare portal and look for the link that says 'View my ID card'. You can print or download your ID card. If you are unable to access the healthcare portal, please call BMI’s Customer Service at 417-782-1515.

How can I get a copy of my Plan Benefit Booklet?

Contact your Human Resource Department or the BMI service team.

How can I correct information that BMI has on file, such as the spelling of my name, my address or date of birth?

You or your Human Resources department may call a BMI Customer Service Representative at 417-782-1515.

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