Administrative Service Agreements for Employer-Sponsored Health Plans
The legal and administrative requirements that apply to employer-sponsored health plans seem to become more complicated every year, and the services that third-party administrators (TPAs) provide to those plans grow accordingly. The contracts between health plans and their TPAs need to address more issues, and in more detail, than in the past. In addition, as in-house benefits and legal staff and TPAs learn from past problems, they are becoming more sophisticated in their understanding of their respective obligations and how to address those obligations when negotiating their contracts. Careful drafting; careful review by legal, financial, and benefits staff; and a comprehensive approach are all necessary to establish a workable administrative services agreement and to provide appropriate protection for the health plan, the employer that sponsors it, and the TPA.
Join Christine Williams, founder of Health Plan Plain Talk, as she reviews the elements of administrative service agreements for employer-sponsored health plans, provisions that should always be included, provisions that should never be included, and the need for careful and precise language in the agreements.
WHAT YOU'LL LEARN
- Who should be on the contract negotiating team and who should be on the review team
- Describing the duties and responsibilities of each party in a health plan’s administrative services agreement
- How fiduciary duty should be addressed
- Fees of the TPA: Amounts and how paid
- Audit rights of the health plan and periodic accountings
- Subrogation obligations of each party
- Indemnification provisions
- Legal remedies available and monetary limits on damages
- Funding of claims paid
- Responsibility for handling claims and appeals of benefit denials
- Technology requirements
- Provisions for termination or amendment of the contract
- AND MUCH MORE!
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