PAI’s Specialty Products and Business Process Outsourcing

Building off our model of providing flexible solutions with top-level service, PAI’s broad portfolio has included administration of programs for national carriers since 1984. We provide an array of administrative services including major medical and dental, limited medical and ancillary benefits for more than 300,000 members and we are licensed in all 50 states.

PAI places a great emphasis on quality with weekly audits for claims and customer service, as well as a call coaching program for customer service advocates.

PAI uses these programs and initiatives to support and enhance our customer service:

Core team of customer service advocates with primary goal of supporting the enrollees
Combined provider and member calls to ensure experience is equal to all parties
Language Line Assistance — over 144 languages for translation
100% of calls are recorded and logged

Our approach is to collaborate with our partners to develop an administrative approach that supports their business. We offer a full menu of administrative services, from “back room” claims, customer service, enrollment support, and member communication design, production and fulfillment.

We also partner with multiple national carriers to offer limited benefit medical plans and ancillary products to part-time and hourly workers on a list bill and payroll deduction basis, and developed the administrative tools to match member eligibility to payroll deductions on a weekly/bi-weekly/semi-monthly or monthly basis.
In response the changing market PAI launched Affordable Care Act (ACA) compliant plans to accommodate large group employer federal mandates. Today, these plans include both self-funded and fully insured options.

Suite of Products

Fixed indemnity medical limited benefit plans offer affordable health care options for your part-time and hourly employees.
Dental
Vision
Term life, including an AD&D option
Short-term disability - Can be offered with no Evidence of Insurability and an entry-age rate freeze
Accident - This limited benefit supplements medical plans with fixed payments for covered accidents.
MEC and MEC+ plans– Cost-effective wellness/preventive benefit plans
Value added and discount program benefits - Exclusive savings for our members for hearing aids through Beltone and TruHearing, vision discounts through QualSight LASIK, Vision Discount Program, Allergy Control Products and National Allergy, alternative medicine with ChooseHealthy.

Pharmacy Network Solution

PAI partners with OptumRx, providing services that create smarter healthcare connections to help your members realize improved care, lower costs and a better overall experience. OptumRx is one of the largest pharmacy benefit management solutions with access to more than 68,000 pharmacies nationwide, and serving more than 13.5 million members.

Medical Network Solution

Our medical network is First Health. First Health Network provides access to approximately 5,500 hospitals and more than 710,000 doctors and health care professionals across all 50 states and the District of Columbia. Ninety-six percent of the U.S. population has access to a First Health Network physician within 10 miles and a First Health Network hospital within 20 miles.

Enrollment and Billing Options

PAI has two enrollment system platforms, including an online portal which we specifically designed for franchise businesses with online and paper enrollment methods, and can accept enrollment via an outside enrollment vendor/834 file.

Secure Employee, Group and Provider Portals

My Benefits Manager^SM Member Portal + App

My Benefits Manager benefit portal links members to all the tools they need to manage their benefits. It is a single secure source for information about members’ specific benefit plans.
Members can securely log into their account through www.paisc.com or download the “My PAI” mobile app to:

Find a network provider
View plan document and benefit summaries
Access claims and explanation of benefits
Print, view, share or request an ID card
Access pharmacy benefits
Access forms
View member discounts and value-add programs
Email Customer Service

My Benefits Manager Provider Portal

Providers use My Benefits Manager to submit or check the status of a pre-determination/pre-authorization, to check the status of a claim, view remittances and explanation of benefits (EOBs), check member eligibility and view a member’s benefit usage and limitations.

My Benefits Manager Employer Portal

You can view employee ID cards, plan documents, and group-specific brochures. You can also search for claim status.