Our “health plan hygiene” series has focused on steps that fiduciaries of employer-sponsored group health plans can take to ensure they meet their fiduciary responsibilities. This issue has been brought to the forefront recently due to a wave of class action lawsuits that have been brought against group health plan fiduciaries. In our last post
TPA
Health Plan Hygiene Part 3 – Best Practices for TPA Evaluation, Selection, and Contracting
A health plan’s fiduciaries are responsible for administering the health plan. Because most employers are not in the business of administering health benefits, they outsource the day-to-day health plan administration to a third-party health plan administrator (TPA). This outsourcing does not mean the employer is off the hook for their fiduciary obligations under ERISA. Even…
Mental Health Parity – Don’t Be Left Out in the Cold!
News Flash: There’s no actual statutory mandate that employers offer group health coverage at all, much less coverage for specific conditions. However, federal law requires health plans that provide mental health and substance use disorder coverage to ensure that the financial requirements (like coinsurance) and treatment limitations (like visit limits and provider access) applicable to…
Health Plan Sponsors – Have You Updated Your Vendor Agreements for Substance Use Disorder (SUD) Confidentiality Regulations?
By Joseph J. Lazzarotti on
Posted in Employee Health & Welfare Plans, Medical Plans
Employers that sponsor group health plans (medical, dental, vision, HFSA) are used to negotiating detailed administrative services agreements with vendors that provide services to those plans. Many also are familiar with “business associate agreements” required under HIPAA that must be in place with certain vendors, such as third-party claims administrators (TPAs), wellness program vendors, benefits…