I have been a client of SOMI for almost 14 years. During that time, I never failed to be impressed with their resourcefulness and ability to help us solve what seemed to be intractable problems. Their service orientation is unsurpassed.
 Vice President of Human Resources & Administration

There are many reasons a company may determine that it makes sense to self-fund its medical plans.  When compared to traditional fully-insured plans, self-funded programs can offer several advantages including:

  • Control over benefit offerings
  • Control over plan design and costs
  • Elimination of state-mandated requirements
  • Flexibility in offering multiple plan choices
  • Reduced fixed expenses
  • Custom reporting
  • Stop loss protection based on risk tolerance
  • Improved claims management and control

SOMI offers comprehensive services in the design and administration of medical plans.  We can work within existing plan designs or help design new plans to meet your needs.  Our services include the ability to:

  • Manage and contract with all plan vendors such as Preferred Provider Organizations (PPOs), Pharmacy Benefit Managers (PBMs), Stop Loss, Utilization Review (UR), specialty services
  • Assist in rate and financial guidelines for appropriate funding
  • Handle all enrollment and eligibility loads and feeds
  • Draft legal plan documents and on-going amendments and plan changes
  • Produce ID cards and required forms
  • Coordinate transition from current administrator
  • Perform enrollment meetings
  • Implement legal updates and legislative requirements
  • Integrate claims processing with PPO partners
  • Integrate with and monitor PBM
  • Provide trigger diagnosis reporting and disease management program
  • Manage coordination of benefits
  • Prepare and manage appeals
  • Present monthly claims and analytical reports
  • File 1099s
  • Prepare 5500 tax forms