Under ERISA, employers have fiduciary responsibilities and resultant liability when they are involved in administering a group health plan and/or controlling plan assets. These fiduciary duties include acting solely in the best interest of plan participants, applying due diligence to ensure plan costs are reasonable and bring value, and acting in a prudent manner in carrying out his/her duties.
Whether self-funded or fully insured, whether using a third-party administrator or a traditional health plan, there are terms within most health plan agreements that, as part of your good faith compliance effort, you want to look specifically for (to make sure they’re included) and terms that you probably want to look out for (so you can get them excluded). This program will provide you with knowledge needed to help ensure you have background information to assess your contracts and fulfill your responsibilities as a fiduciary.
AGENDA
10:00 am
Program Overview
Robert Smith, CBGH 5 min
An introduction regarding the importance of the topic and of our guest speakers.
10:05 am
TPA and PBM Contracting Terms You Want to Watch out For
Marilyn Bartlett, CPA
Plan Sponsors contract with TPAs and PBMs to provide services to their Plan, but may not be aware of some of the complex contract provisions that could create overspending or Fiduciary role conflicts. Marilyn will examine common TPA and PBM contract clauses that a Plan Sponsor/ Fiduciary should be aware of to fulfill their responsibilities.
10:35 am
Turn Your ERISA Liability into an ERISA Opportunity
Christin Deacon, JD
ERISA has long been known as a legal vehicle for employee led class actions against retirement plan administrators for breach of fiduciary responsibilities. Less well known, but equally as substantial, is the increased exposure employers have under ERISA related to health plan administration.
We will unpack the hidden exposure and learn ways to turn potential liability into a vehicle for greater accountability, oversight, and healthcare savings.
11:05 am
Questions & Discussion
Participants
