Claims
Claims and enrollment support
When one of your employees has a problem with a claim, a bill or their coverage, they call us directly and we deal with the carrier on their behalf. That includes denied claims, surprise bills, ID cards, adding new hires, removing leavers, and life events mid-year. It’s included, it’s not a ticketing system, and it’s the part of the job we’d want you to judge us on.
What this looks like in practice
Normally
An employee opens a hospital bill for an amount they were certain was covered. Normally that becomes your problem: your office manager spends two hours on hold, gets nowhere, and the employee decides the benefits are worthless.
Instead
Instead they call us directly. We read the explanation of benefits, work out whether it was coded wrong, processed wrong or genuinely not covered, and take it up with the carrier. Then we tell the employee what happened, in language they can follow.
Enrollment, all year
- New hires added and walked through their options
- Terminations processed, with COBRA handled properly
- Qualifying life events: marriage, birth, a spouse losing coverage
- Replacement ID cards, which sounds trivial until it’s you
- Open enrollment meetings on site, in English and Spanish
None of this is a premium service. It’s what we think a broker is for.
Compliance
Compliance support
We keep track of what your plan legally has to do and we walk you through it. That covers ACA reporting, ERISA plan documents and summary plan descriptions, COBRA, Section 125 documents, required employee notices, and non-discrimination testing. Julie handles the regulatory filings and Cody walks you through what each one means and what you have to decide.
The mistake employers make without knowing
Non-discrimination testing is the one that catches people. Section 125 plans and self-funded arrangements have rules about how much better you can treat highly compensated employees than everybody else. Owners often set something up that feels generous and reasonable, and it quietly fails a test they did not know existed. Nobody finds out until it matters.
What changed for 2026 reporting
- March 2, 2026 Availability notice posted, for 2025-year forms
- October 15, 2026 Notice stays accessible until
- January 31, 2026 Forms provided on request by, or within 30 days of the request
- March 31, 2026 Electronic filing with the IRS due
Two federal laws changed employer reporting obligations. Employers no longer have to mail 1095-B and 1095-C forms to every employee, provided they post a clear and accessible notice telling employees they can request one. For 2025-year forms, that notice had to be up by March 2, 2026 and stay accessible until October 15, 2026. On request, the form has to be provided by January 31, 2026 or within 30 days of the request, whichever is later. Electronic filing with the IRS was due March 31, 2026.
Two other changes are worth knowing: the statute of limitations was extended to six years, and employers now get 90 days rather than 30 to respond to a proposed penalty assessment.
Sources: the Paperwork Burden Reduction Act and the Employer Reporting Improvement Act, both signed December 2024.
How we do it
You get a compliance calendar with what is due and when, the documents drafted or reviewed, and a phone call to walk through anything that needs a decision. Not a PDF in an email with your best wishes attached.
We are benefits advisors, not attorneys or accountants. Compliance support is general guidance, not legal or tax advice.
HR technology
Employee Navigator, at no cost to you
We set up and run Employee Navigator for our clients at no charge to the business. It handles onboarding, benefits elections, employee self-service and carrier feeds, so open enrollment stops being a stack of paper forms on someone’s desk. We implement it, we configure it and we maintain it. You don’t pay for it and you don’t set it up.
What it replaces
- Paper enrollment forms, and chasing the four people who haven’t returned them
- A spreadsheet that is out of date the moment someone starts or leaves
- Retyping the same information into three different carrier portals
- Employees emailing your office manager to ask what plan they’re on
What your team gets
New hires complete their elections online before their first day. Employees can see their own coverage, what they elected and what it costs them per paycheck, without asking anyone. Changes flow through to the carriers rather than being re-keyed by hand. ID cards come from the carrier’s own app or website, and we help anyone who gets stuck setting that up.
If you already have software you like, keep it
We’re not tied to any one system. If your payroll or benefits administration software is working for you, we’ll work inside it instead of asking you to switch. If you’d rather stay on paper forms, we can run it that way too. What matters is that the admin gets done, not which tool it gets done in.
For a business with 20 or 30 people this is usually the biggest practical change when you move to us, and it’s the one nobody sees coming.
A year with us
What a year with us looks like
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90 days before renewal.
We request the renewal and your claims experience where it’s available.
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60 days.
Your census goes to market. We build the comparison.
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45 days.
We sit down with you and make the decision together.
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30 days.
Enrollment meetings, on site, in both languages. Employee Navigator is opened up for elections.
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Renewal.
Everything is loaded, cards are issued, feeds are running.
Those are the latest points, not the usual ones. We start as early as your carrier will release the renewal, so your options are often in front of you well before the 45-day mark.
The other eleven months.
Claims, new hires, leavers, life events, ID cards, compliance dates, and the occasional question at nine at night that we’ll answer in the morning.
People we work with
People we work with
Benefits sit next to a lot of other things a business has to get right, and we would rather point you to someone good than pretend we do all of it ourselves.
We work regularly with an HR consultant, a payroll firm and a property and casualty agent. They are independent businesses, not part of ours. If you need one, ask and we’ll introduce you. If you already have people you trust in those seats, that’s fine by us and we’ll work alongside them.
- HR support
- Payroll Affiliated HR and Payroll
- Property & casualty insurance
We don’t take a fee for these introductions. If that ever changes, we’ll say so on this page.
How do I change benefits brokers?
You sign a one-page Agent of Record letter naming us on your existing policy. Nothing else changes. Your plan, carrier, network, deductible, price and ID cards stay exactly as they are until your renewal, your employees do nothing, and there is no cost. It can be done at any time of year.
Broker compensation is already inside your carrier’s rates, so using a broker doesn’t add to your premium. The only question is whether the one you have is doing anything for it.