Overview of Basic Operations

The Pool consists only of political subdivisions, primarily municipalities, which join together through Interlocal Agreements to provide health benefits to employees, officials, retirees and the dependents thereof. Provider agreements are in place, which enable the Pool to obtain services and DME at a discount. Economies based on provider contracts are passed on to Pool participants in the rate setting process. The Pool also provides Administrative Services only to political subdivisions, which self-fund their health benefits.
As of October 2008, the Pool services 694 Members.

Areas of Importance

1. Understanding we work for the political subdivisions in the State of Texas
   
   
2. Quality and production are the two areas of constant focus. Month-end statistics are reviewed
   
   
3. Ensuring Healthcare is cost-effective is currently one of our areas of primary focus
   
   
4. TML IEBP currently takes risk on the first $500,000 per claim
   
   
5. Erroneous billing is another area of continued management
   
   
6. Correct eligibility is a primary area of managing costs
   
   
7. Service Teams need to work together to exchange information so healthcare services and cost can be managed and claims paid accurately
   
   
8. Service Teams
   1. First Floor
      • Accounting includes: account receivables and account payables, purchasing and receptionists
      • Underwriting includes: underwriting, cost analysis, stop loss and stop loss audit
      • Marketing includes: Provider Contracting and Benefit Service Specialists, Marketing Service Assistant and Credentialing
      • Executive includes: Executive Director, Chief Information Officer, Human Resources and Legal/Right of Recovery, Privacy Officer
   2. Second Floor
      • Quality Management includes: Plan Builders, Training, Audit and Manager
      • Support Services includes: Mailroom, Provider Update, scanning of claims and billing & eligibility forms, coordination and auditing of third-party claims data capture, and auditing of claims repricing
      • Information Technology includes: hardware management, software management, programming and Manager
      • Member Service Team includes: Claims Analysts, Team Service Assistants, Team Support Specialists, Coordinators and Manager
   3. Third Floor
      • Medical Care Management includes: notification, concurrent review, discharge planning, Claims Liaison, Disease Management, Transplant Management and Manager
      • Billing & Eligibility, and Customer Service

Financial Stability
TML IEBP works consistently to manage the financial integrity of the Pool. TML IEBP strives to maintain operation costs which do not exceed 15% of its total revenue. Member equity may be used for rate stabilization during periods of unusually high claims experience. The Membership has consistently emphasized the request for rate stability, and TML IEBP works diligently to manage contribution rates.

Benefit funding levels for manual rates are affected by geographic area, employee age/gender, plan design, medical inflation and medical utilization. Every three years an external actuary audits TML IEBP's funding levels, manual-rating system and network discounts to ensure fiscal integrity. The Pool purchases individual and aggregate reinsurance to assist in rate stabilization.