A MATRIX Minute by MATRIX Group Benefits, LLC
It was the year 2000 when the foundation for Matrix Group Benefits, LLC was first discussed with the head of underwriting for Canada Life. The hysteria of Y2K had come and gone, and everyone knew that business life and its reliance on computers and the internet would continue and would increase in the future. This realization made the formation of MATRIX feasible as we launched the company in February 2001 with one person in Maine, one in Arizona, a service agreement with a company in Indiana and our consulting underwriting expert in Canada. When we initially discussed how we could make this remote business network model work, most people questioned its efficacy. Fast forward to today and most companies have remote locations all over the world and millions of people work from home.
As the MGU took form and secured its MGU agreement and first Treaty in 2001, the first cases began to be written. Many of the early cases were the result of established relationships with consultants and services provided to plan sponsors prior to the formation of MATRIX. Many of those relationships and clients continue today, twenty or more years after their inception. As the MGU started to grow, Matrix Risk Management Services LLC (RMS) was launched based on the Utilization Management and PPO models and processes that we used in prior roles managing utilization review programs and provider networks. The fundamental principles of early identification and intervention still guide the services provided to plan sponsors by RMS.
As MATRIX developed, U.S. Group and Pension, LLC (U.S.G&P) was added to serve as a general agency for the marketing of medical stop loss and other products and services. Today U.S.G&P continues to provide marketing and sales support for MATRIX.
Over the course of the past twenty years, MATRIX has been, and continues to be, a niche market leader providing unique underwriting programs and an early adopter of many approaches for claim cost management. Our PLATINUM program, introduced when MATRIX was formed, still serves as our core stop loss program. Platinum is designed on the principles of financial stability and leveraged trend and selection of coverage options by the plan sponsor. The combination of leveraged trend with established rate increase caps provided, to the best of our knowledge, the first product with a rate cap option. Platinum has also since its inception included a unique approach to risk sharing for lasers for known ongoing large claims. This unique approach continues today and is again, to the best of our knowledge, the only model of its type.
The MATRIX approach to medical stop loss was also concerned about the inherent risk of conflict between claims and underwriting, also known as underwriting at the point of claim. To assure objectivity in claim review and to separate claims from underwriting, Matrix outsourced the claim analysis function to an independent claim auditing firm, and also engages the services of independent review firms when a claim involves technical or complex medical questions. The objectivity and transparency of the independent claim review eliminates virtually all questions about claim decisions and has enabled MATRIX to approve plan sponsor’s requests for reimbursement when the initial review of a claim made it appear that it may be considered ineligible.
Our RMS service has continued to expand its expertise and relationships with specialty resource companies to support our clients and consultants. The collaboration with vendors and networks contracted by plan sponsors and with their benefit administration staff members has resulted in more than just cost savings for the plan, it has helped plan participants navigate their way through the healthcare delivery system. Today RMS is focused on many of the new emerging therapies, procedures and drugs and expanding its resources to help clients and consultants adopt strategies to manage the impacts and financial risks these advancements represent.
We celebrate twenty years this month thanks to our staff, our colleagues, consultants, clients and medical stop loss insurers. We look forward to serving you for many more years.
Inviktus 