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Altogether Now

On March 4, 2022
Wondering what to do about the increasing costs of providing health benefits? Learn about moving from a traditional insurance model to a self-funded plan.

Being a Prudent Plan Fiduciary Has Gotten Harder

On February 18, 2022
Learn about the Hughes v. Northwestern University ERISA case and how this affects the responsibilities and risks for liabilities of plan fiduciaries.

Stop-Loss “Gaps”: Level Funding Is Far From Immune

On December 6, 2021
Learn about level funding, how it can eliminate the high aggregate claims risk and how to identify areas where gaps in coverage are likely to arise.

Revisiting PPO Contracts & Stop-Loss Gaps

On April 26, 2021
Learn about the risks associated with stop-loss insurance for self-funded health plans and the importance of identifying coverage gaps early. Read more.

Doe v. United Behavioral Health – A Fiduciary Twist

On April 9, 2021
Learn about how a self-funded plan's application of an exclusion led to a lawsuit brought against their claims administrator and why it has TPAs concerned.

Discretion vs. Actual Decisions

On November 2, 2020
How can discretionary authority play a part in a plan document? Click to find out what discretionary authority is with examples and the impact it can have.

Plan Mirroring: What Does It Really Mean?

On August 26, 2020
Plan mirroring provisions can be marketed to make a stop-loss policy airtight for the plan, but there is still the potential for a gap. Learn more!

The More You Know, the More You Save: How Transparency in Health Care Can Help Empower Patients and Plans

On December 5, 2019
The goal of the executive order and the resulting proposed rules is to make the cost of healthcare transparent for patients. Learn more about changes.

Happy (Almost) New Plan Year!

On November 6, 2019
Don't let the hectic Fall season bring you down - we've compiled helpful tips for employers to keep in mind as they review health plans for the new year.

The “Greatest of Three” Rule & Barriers to Compliance

On October 17, 2019
Seeing a plan get sued over a denial isn't good, but can compel useful guidance. The issue is its failure to provide information needed to comply.

Lots of Moving Parts

On September 11, 2019
As self-funders know, there are multiple considerations involved in most decisions. Even negotiating a pre-payment bill can involve many questions.

Everything I Ever Needed to Learn, I learned in Pre-School!

On June 26, 2019
As the saying goes, many of the basic skills we need to be effective in life are taught to us early. “Use your words” – a common instruction given to young children who are struggling to express themselves or communicate effectively, is an instruction I still use daily – albeit with a slight adjustment. Especially with matters relating to plan administration, words alone aren’t enough! it’s important to use the correct words to avoid any confusion and ensure that everyone reading the plan understands exactly what you mean!

Big Pharma Executives Testify Before Congress (Again)

On May 3, 2019
Executives from major drug companies testified before the Senate Finance Committee. Read about their proposed solutions for price increases & transparency.

Beware The “Lesser Of”

On April 23, 2019
Learn more about avoiding problems with the plan document obligating the Plan Administrator to pay less than the amount required by a separate contract.

ERISA Violations Due to Restrictive Claim Guidelines

On March 25, 2019
A recent case development has added another layer to compliance when it comes to covering mental health benefits. Click to read more.
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