From Hang Gliding to Hard Savings: A Risk Exclusion That Paid Off

A broker servicing a self-funded plan asked whether a plan’s hazardous activities exclusion could be utilized to deny a very large claim incurred as a result of injuries stemming from hang gliding. The Phia Group issued a consulting opinion, which explained the plan language subtleties in such an exclusion and the potential stop-loss implications as well. The Phia Group also walked the client through the analysis of applying the Plan Document language to these particular claims.

 

Upon completion of The Phia Group’s review and analysis, the employer and broker had a better understanding of how to apply its hazardous activities exclusion for future claims. In this case, the Plan Administrator determined that it was able to exclude the claim by applying The Phia Group’s explanation to the claims at hand. Additionally, The Phia Group suggested certain language changes to bolster the Plan’s exclusion, which increased the potential for future savings.

 

By partnering with The Phia Group, the self-funded plan saved $355,000 by understanding why and how these claims were not eligible under the terms of the Plan Document.