FIDUCIARY RESPONSIBILITY AND YOU. Tim Callender, The Phia Group
|
|
|
- Antony Cameron
- 5 years ago
- Views:
Transcription
1 FIDUCIARY RESPONSIBILITY AND YOU Tim Callender, The Phia Group
2 Innovation and Cost-Containment - In the Self-Funded Space - Presented By Tim Callender Vice President Sales & Marketing The Phia Group, LLC tcallender@phiagroup.com
3 The Phia Group LEARN Various Legal & Consulting Services PLAN Plan Document Services & Software SAVE Claims Recovery, Negotiation, Network Alternatives PROTECT Plan Administration Defense & Outsourcing Fiduciary Duties OUR MISSION: To reduce the cost of healthcare through innovative technologies, legal expertise, and focused, flexible customer service. We support employment based group health insurance and are confident that selffunded health plans lead the way.
4 Today s Overview Healthcare Costs are Awesome Not Really Top Two Innovative Solutions Fiduciary Transfer Subrogation Other Trends in Self-Funding, The Laundry List
5 Healthcare Costs are Awesome Not Really
6 Healthcare Costs Out of Control Why? Lack of transparency Convoluted and confusing system The wrong incentives Payer, Provider and Plan Sponsor tolerance & paying the wrong claims We ve made this mess together we can fix it together
7 Healthcare Costs Out of Control Why? Lack of Transparency $57 for a FRED (Fog Reduction Elimination Device: a 2 in. square gauze strip used to wipe moisture from lenses in the operating room) $200 for a bag of IV solution $985 pair of scissors $1,028 for a 1oz. container of contrast solution $11 for a mucous recovery system (a box of tissues) $350 for an IV kit
8 Healthcare Costs Out of Control Why? Some of the worst offenders: Air Ambulance Charges are typically 400%-500% of Medicare allowable rates Implantable Devices Devices typically marked up between 500% and 1,000% of cost Some providers get gouged on the procurement side as well Dialysis Dialysis facilities routinely charge 1,000% to 2,000% of Medicare allowable rates
9 Ah Memories
10
11
12 Healthcare Costs Out of Control Why? Payer and Plan Sponsor Tolerance If you feed a dog steak when you bring him home, he ll expect steak for every meal We have to work together and eat Tofu sometimes or maybe just cheaper steak
13 What Can We Do? Work with best in class partners like Cypress to innovate and contain costs Self-funding is the vehicle we can use to create and maintain savings while delivering healthcare and providing fair reimbursement to providers Educate, educate, educate this is where you differentiate Transparency & dialogue with all stakeholders Tim s Top Two things we can do, coming up next
14 Top Two - Fiduciary Transfer - - Subrogation -
15 Fiduciary Transfer Fully-insured v. ASO self-insured v. pure TPA self-insured In a fully insured model, the carrier is the fiduciary In an ASO model, the carrier is the fiduciary sort of In a pure TPA self-insured model, the Plan is typically the fiduciary, fence to fence Very large barrier to pure self-insurance has become fiduciary concerns There s also a gap in the ASO model Solution: transfer that fiduciary liability to a third party
16 Fiduciary Transfer Mason v. FedEx Corp (D. Alaska 2016) TPA & plan sponsor sued by plan member for breach of fiduciary duty over appeals process, asserting TPA had a financial interest in returning appeals determinations that denied benefits Holding: TPA and plan sponsor had a conflict of interest in how the appeals process was setup Dragu v. Motion Picture Ind. Health Plan (N.D. Cal. 2015) Plan member sues plan sponsor for breach of fiduciary duty over a misapplication of plan terms Holding: Plan Sponsor misconstrued the terms of its plan which equaled a fiduciary breach
17 Fiduciary Transfer Pac. Shores Hosp. v. United Behavioral Health (9 th Cir. 2014) TPA & plan sponsor sued by provider for breach of fiduciary duty under an assignment of benefits for refusal to pay inpatient benefits Holding: plan sponsor failed to adequately review benefit determinations and breached its fiduciary duty Connt. Gen. Life Ins. v. Humble Surgical Hosp. (S.D. Tex. 2016) TPA & broker sued by provider for breach of fiduciary duty over out-ofnetwork payment issues and overpayment collection efforts Holding: $2.3 million award to the provider under a finding of breach of fiduciary duty
18 Fiduciary Transfer The Phia Group s Plan Appointed Claim Evaluator (PACE) Service Keeps costs down through: Objective & accurate interpretation of your plan document Stop paying claims you should not be paying Alternatively, avoid denying claims you should not be denying Outsourcing of difficult, final, internal appeals
19 Fiduciary Transfer The Phia Group s Plan Appointed Claim Evaluator (PACE) Service Plan document review Educational webinars Stop-loss policies reviewed gap analysis! Phia performs an assessment of final, internal appeals and issues a directive, as a fiduciary Defense of decisions in the face of external scrutiny Let someone else handle the external review headaches & costs
20 Subrogation & Overpayment Recovery Recover third-party dollars that belong to the Plan Keep the Plan solvent & healthy Help the Plan meet their fiduciary duty I guarantee there are Plan dollars being left on the table Auto accidents, class actions, toxic torts, Rx & implant/product recalls Medicare COB and obtaining overpayment recovery from providers Group can set pursuit parameters VIPs?
21 Subrogation & Overpayment Recovery You should be maximizing case identification Legal support & knowledge of state law is key Common Fund Doctrines; Made Whole Doctrines Customized! All this without creating member disruption = you are the hero that brought this solution
22 Subrogation & Overpayment Recovery The current recovery landscape Montanile = That million dollar settlement you should probably go spend it on narcotics and a vacation to Cabo Dirty rotten Plaintiff s Lawyer
23 Other Trends in Self-Funding
24 Education & Incentives Lunch & Learn? Open enrollment meetings? Loop in providers! Choice of hospitals patients pay lower or no coinsurance at lower-cost hospitals Certain hospitals can be paid at no OOP and even cash rewards Maternity care: diapers, baby wipes, gift card Percent of savings for finding errors and finding alternatives Ex. Nebulizer: $300 with 30% discount or on Amazon for $118 Medical tourism & family vacations give them the difference Wellness goals throw a party
25 Disrupt The Market Some proven ideas some crazy ideas Claims negotiation with sign off (coupled with patient advocacy) Revocation of the assignment of benefits 501(c)(3) non-profit Report as self-pay Remember The Bloody Toe what if Tim walked in and said, hi, I don t have insurance Car insurance
26 THANK YOU Text PHIA to to join our mailing list Join Us for Our Next Free Webinar: Check out our podcast: thephiagroup.podomatic.com
OVERVIEW ERISA MAN LIVES!?!? ERISA MAN IS DEAD... THE PRICE IS RIGHT INTRODUCTION FIDUCIARY DUTY IT S CATCHING ON! YOU SNOOZE YOU LOSE
OVERVIEW INTRODUCTION FIDUCIARY DUTY IT S CATCHING ON! YOU SNOOZE YOU LOSE ERISA MAN LIVES!?!? ERISA MAN IS DEAD... THE PRICE IS RIGHT TO ASSIGN OR NOT TO ASSIGN GREAT QUESTION! 1 INTRODUCTION SPEAKER
Checklist and Helpful Tips for Dealing with Liens in Personal Injury Cases
Checklist and Helpful Tips for Dealing with Liens in Personal Injury Cases Tyler H. Bridgers The Simon Law Firm, P.C. 2860 Piedmont Road NE, Suite 210 Atlanta, GA 30305 678-608-2788 tyler@simon.law georgiaclaims.com
ISSUE OF THE YEAR: REFERENCE BASED PRICING AND BALANCE BILLING Presented By: Adam V. Russo, Esq. CEO Ron E. Peck, Esq. Senior VP and General Counsel December 15, 2015 www.phiagroup.com PgcReferral@phiagroup.com
The Employee Retirement Income Security Act of 1974
CHAPTER 18 SAMPLE ERISA PLAN DOCUMENT CHECKLIST l The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for most voluntarily established pension and health
The challenges of setting up and administering an employer-sponsored, self-funded health. Drowning in A Sea of Paper. Written By: Tim Callender, Esq.
Drowning in A Sea of Paper Written By: Tim Callender, Esq. The challenges of setting up and administering an employer-sponsored, self-funded health plan are many. One of the largest challenges a self-funded
Mistakes to Avoid If You Are in a Georgia Car Wreck
Mistakes to Avoid If You Are in a Georgia Car Wreck JAMES K. MURPHY Murphy Law Firm, LLC Georgia Accident & Injury Attorney 8302 Office Park Drive 2 Table of Contents: Preface: Who is Behind This Book,
Simple Facts About Medicare
Simple Facts About Medicare What is Medicare? Medicare is a federal system of health insurance for people over 65 years of age and for certain younger people with disabilities. There are two types of Medicare:
ERISA FIDUCIARY RISK IS THE LARGEST UNDISCLOSED RISK I VE SEEN IN MY CAREER l
CHAPTER 19 ERISA FIDUCIARY RISK IS THE LARGEST UNDISCLOSED RISK I VE SEEN IN MY CAREER l Written with Sean Schantzen The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets
Solutions. The facts of the latest. Subrogation Rights in Montanile Case. The Supreme Court Seeks. to the Latest Challenges to
The Supreme Court Seeks Solutions to the Latest Challenges to Subrogation Rights in Montanile Case Written by Catherine Dowie 4 The Self-Insurer www.sipconline.net The facts of the latest healthcare subrogation
Chapter 8. Your rights and responsibilities
Chapter 8: Your rights and responsibilities 1 Chapter 8. Your rights and responsibilities SECTION 1 Our plan must honor your rights as a member of the plan... 1 Section 1.1 We must provide information
Gilsbar 360 Alliance PROVIDER MANUAL. Gilsbar.
Gilsbar 360 Alliance PROVIDER MANUAL Gilsbar www.gilsbar360alliance.com Dear Provider: Gilsbar is building a PPO network that gives providers and employers the opportunity to truly work together. We ve
Medicare Made Clear Answer Guide
Medicare Made Clear Answer Guide Y0066_100820_113217 File & Use 08252010 Medicare can be confusing. How do you find the best options to fit your needs? This guide has some answers that may be helpful.
MCHO Informational Series
MCHO Informational Series Glossary of Health Insurance & Medical Terminology How to use this glossary This glossary has many commonly used terms, but isn t a full list. These glossary terms and definitions
IN THE UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF MISSOURI WESTERN DIVISION
IN THE UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF MISSOURI WESTERN DIVISION RICHARD BARNES, ) ) Plaintiff, ) ) v. ) No. 4:13-cv-0068-DGK ) HUMANA, INC., ) ) Defendant. ) ORDER GRANTING DISMISSAL
The Auto Club Group Retiree Health Program. Medicare-Eligible Retiree Guide
The Auto Club Group Retiree Health Program Medicare-Eligible Retiree Guide Replacing Your Auto Club Group Retiree Health Plan Did You Know? With the Aon Retiree Health Exchange, you could potentially pay
Glossary of Health Coverage and Medical Terms x
Glossary of Health Coverage and Medical Terms x x x This glossary defines many commonly used terms, but isn t a full list. These glossary terms and definitions are intended to be educational and may be
401(k) Checklist: What to Ask When Evaluating Providers
401(k) Shopping Checklist: Employee Experience Routine Admin Work Compliance Cost Investment Selection 401(k) Checklist: What to Ask When Evaluating Providers Your Goal Select a 401(k) provider that saves
CHAPTER 3: MEMBER INFORMATION
CHAPTER 3: MEMBER INFORMATION UNIT 4: COORDINATION OF BENEFITS IN THIS UNIT TOPIC SEE PAGE 3.4 COORDINATION OF BENEFITS (COB) 2 3.4 COB: TWO AND THREE PAYER CLAIMS Updated! 4 3.4 FREQUENTLY ASKED QUESTIONS
Burdensome ERISA Document Requests and How to Respond: The Important ERISA Documents and What Your Opponent Really Needs
The Summit of Subrogation: Climbing to New Heights Burdensome ERISA Document Requests and How to Respond: The Important ERISA Documents and What Your Opponent Really Needs Today s Speakers: LAWRENCE &
ALEXANDER MURRAY QUESTIONNAIRE January 2018
ALEXANDER MURRAY QUESTIONNAIRE January 2018 Fielded by: Nielsen Scarborough Fielding Dates: Dec 6 13, 2017 Sample size: 2511 registered voters (RVs) Margin of Error: +/ 2% Note: Text in [brackets] was
The Top 3 Advantages of Self-Funded Plans
The Top 3 Advantages of Self-Funded Plans How Employers Benefit from Flexibility, Plan Savings & Employee Engagement A Whitepaper Presented By Contents 1. Introduction: TODAY S OUT-OF-CONTROL HEALTH COSTS
ALLIANCE HMO WITH HRA MEDICAL PLAN
ALLIANCE HMO WITH HRA MEDICAL PLAN What is the Plan? This is a health plan that offers access to physicians selected based on their ability to guide their patients to the care and resources that help promote
Patient Billing and Financial Services
Patient Billing and Financial Services UNDERSTANDING YOUR OBLIGATIONS BAYHEALTH.ORG We realize this can be a stressful time for you and your family. We particularly understand how frustrating it can be
Medicare + GEHA. Protect yourself from unexpected health care expenses
Medicare + GEHA Protect yourself from unexpected health care expenses Table of contents Facts about Medicare 5 Medicare Part A 6 Medicare Part B 6 Medicare Part C 7 Medicare Part D 8 GEHA + Medicare 10
Problems with Current Health Plans
Problems with Current Health Plans Poor Integration, Coordination and Collaboration - Current plans offer limited coordination between the health plan, Providers, and the Members, as well as limited mobile
HOW TO CHOOSE A MEDICAL PLAN MOTT COMMUNITY COLLEGE
HOW TO CHOOSE A MEDICAL PLAN MOTT COMMUNITY COLLEGE Chadd Hodkinson SET SEG Employee Benefit Services Account Executive The content in this presentation is informational. Each employee should review the
SUMMARY OF MARYLAND STATE EMPLOYEES & RETIREES MENTAL HEALTH AND SUBSTANCE ABUSE PLAN
SUMMARY OF MARYLAND STATE EMPLOYEES & RETIREES MENTAL HEALTH AND SUBSTANCE ABUSE PLAN 2010-2011 Call APS Healthcare, Inc. Toll-Free: 1-877-239-1458 Website: www.apshelplink.com Company Code: SOM2002 Year
Guide to Self-Funding Medical Benefits
Guide to Self-Funding Medical Benefits By: John Harris, CEO CU Benefits Alliance January 2017 This is a general information ebook and discussion guide on self-funding healthcare benefits. Contents Introduction...
MEET PRIYAH MEET JOSH MEET VANESSA MEET MARCO
GETTING READY FOR BIND Meet Priyah, Josh, Vanessa, and Marco. They are Medtronic employees who plan to enroll in a medical plan in November. Get to know their personal situations and what they consider
REINSTATEMENT And IMPLEMENTATION Of LAHIPP THIRD PARTY LIABILITY (TPL) CLAIMS PAYMENT
REINSTATEMENT And IMPLEMENTATION Of LAHIPP THIRD PARTY LIABILITY (TPL) CLAIMS PAYMENT April 7, 2017 LOUISIANA MEDICAID PROGRAM DEPARTMENT OF HEALTH BUREAU OF HEALTH SERVICES FINANCING TABLE OF CONTENTS
Medical Benefits Comparison Book 2018 Medicare Retirees in the Rochester Area
Medical Benefits Comparison Book 2018 Medicare Retirees in the Rochester Area Human Resources Finance & Administration Rochester Institute of Technology Medical Benefit Comparison This information provides
2018 Evidence of Coverage
Centers Plan for Dual Coverage Care (HMO SNP) 2018 Evidence of Coverage H6988_002_ANOC EOC1127 Accepted 09182017 January 1 December 31, 2018 Evidence of Coverage: Your Medicare Health Benefits and Services
If you ve been listening to webinars, attending meetings or pretty much been doing
In Reference to Reference Based Pricing by Ron E. Peck, Esq., Sr. Vice President & General Counsel, The Phia Group, LLC If you ve been listening to webinars, attending meetings or pretty much been doing
The Employer s Essential HEALTH CARE REFORM COMPLIANCE CHECKLIST 2014
The Employer s Essential HEALTH CARE REFORM COMPLIANCE CHECKLIST 2014 HEALTH CARE REFORM COMPLIANCE CHECKLIST: 2014 2 The #1 Online Health Benefits Solution Zane Benefits was founded in 2006 to revolutionize
Prescription Drug Plan (PDP)
Prescription Drug Plan (PDP) Blue Shield of California Medicare Rx Plan (PDP) Evidence of Coverage Effective January 1, 2014 Blue Shield of California is a PDP with a Medicare contract. Enrollment in Blue
HIPAA Notice of Privacy Practices
TM HIPAA Notice of Privacy Practices HIPAA is a federal law that requires protections for your protected health information (PHI). UNITE HERE HEALTH (The Fund) is required to provide you with a detailed
TITLE XXXVII INSURANCE
TITLE XXXVII INSURANCE CHAPTER 404-G INDIVIDUAL HEALTH INSURANCE MARKET Section 404-G:1 404-G:1 Purpose of Provisions. The purpose of this chapter is to: I. Protect the citizens of this state who participate
01 The Actual Car Accident
So how does a personal injury lawsuit work? There s a lot that goes into it. From start to finish, we will discuss how the process plays out, what this means for you if you find yourself in this situation,
PREEMPTION QUESTIONS AND ANSWERS
PREEMPTION QUESTIONS AND ANSWERS ERISA PREEMPTION QUESTIONS 1. What is an ERISA plan? An ERISA plan is any benefit plan that is established and maintained by an employer, an employee organization (union),
A S O. A version of this article appeared in the May 2013 issue of Benefits Canada Magazine. Why are ASO Plans Growing in Popularity?
A version of this article appeared in the May 2013 issue of Benefits Canada Magazine A S O Before selecting a group benefits provider, plan sponsors need to know the basics and the cold hard facts. Set
Your Retirement Guide: A Step-by-Step. Checklist POWER YOUR FUTURE
Your Retirement Guide: A Step-by-Step Checklist d POWER YOUR FUTURE Retirement is a big step. You will be asked to make many important decisions about your DTE Energy (the company ) benefits over the next
PLAN DESIGN AND BENEFITS MC Open Access Plan 1913
PLAN FEATURES PREFERRED CARE NON-PREFERRED CARE Deductible (per calendar year) $1,500 Individual $4,500 Family $4,000 Individual $12,000 Family Unless otherwise indicated, the Deductible must be met prior
ADVANTAGES AND MYTHS OF SELF-FUNDING
ADVANTAGES AND MYTHS OF SELF-FUNDING for employers with fewer than 250 employees 1 Summary Self-funding an employee health benefit plan is a long-term health strategy to save money because it can provide
Sponsored by: Approved instructor
Sponsored by: Approved About the Speaker Nancy M Enos, FACMPE, CPMA CPC-I, CEMC is an independent consultant with the MGMA Health Care Consulting Group. Mrs. Enos has 40 years of experience in the practice
Your Guide to Understanding Medicare 2017
Your Guide to Understanding Medicare 2017 One of the most important decisions you ll ever make for your health & financial wellbeing This guide is not an insurance solicitation or promotion for any particular
You Know You ve Reached Middle Age IF? There s no need to run out and buy a home pregnancy kit Happy Hour with free Hors d oeuvres no long constitutes
Financial Secrets one CRNA to Another Major Peter Strube CRNA MSNA APNP You Know You ve Reached Middle Age IF? There s no need to run out and buy a home pregnancy kit Happy Hour with free Hors d oeuvres
Claims Administrator Questionnaire
Claims Administrator Questionnaire About PartnerRe PartnerRe is an acknowledged leader in providing risk management solutions to accident and health markets around the world. Our team of experienced professionals
Choosing your Medicare Advantage plan is now easier than ever.
Choosing your Medicare Advantage plan is now easier than ever. We get it. Medicare, with all its Parts can get confusing. And, when it comes to choosing a Medicare Advantage plan that s right for you,
Health Savings Accounts
Health Savings Accounts A Guide for Missouri School Districts January, 2007 Forrest T. Jones & Company, Inc. 3130 Broadway Kansas City, MO 64111 800-821-7303 What is a Health Savings Account (HSA)? Health
Financial Well-being SAVINGS
Financial Well-being SAVINGS SAVINGS Savings is a key part of a successful financial wellness plan. Specifically, having not only a basic savings level (emergency fund), but also building up enough savings
The Pros and Cons of Self-Funding Health Coverage
The Pros and Cons of Self-Funding Health Coverage BY LARRY GRUDZIEN ATTORNEY AT LAW : Mar. 20, 2018 Pros and Cons of Self-Funding Health Coverage Self-Funding: What is it? Self-Funding in the Marketplace
Florida Open Access Managed Choice Aetna Life Insurance Company Plan Effective Date: 03/01/2012. PLAN DESIGN AND BENEFITS MC OA Plan A-50
Florida 2-100 Open Access Managed Choice Aetna Life Insurance Company Plan Effective Date: 03/01/2012 PLAN DESIGN AND BENEFITS MC OA Plan 12-3000A-50 PLAN FEATURES PREFERRED PROVIDERS NON-PREFERRED PROVIDERS
Florida Health Network Option (POS Open Access) Aetna Life Insurance Company Plan Effective Date: 03/01/2012
Florida 2-100 Health Network Option (POS Open Access) Aetna Life Insurance Company Plan Effective Date: 03/01/2012 PLAN DESIGN AND BENEFITS HNOption Plan 12-2000-70 PLAN FEATURES PARTICIPATING PROVIDERS
Florida Open Access Managed Choice Aetna Life Insurance Company Plan Effective Date: 03/01/2012
Florida 2-100 Open Access Managed Choice Aetna Life Insurance Company Plan Effective Date: 03/01/2012 PLAN FEATURES PREFERRED PROVIDERS NON-PREFERRED PROVIDERS Deductible (per calendar year) PLAN DESIGN
My employees need a health plan they can trust. I need a plan that lets them control their costs.
My employees need a health plan they can trust. I need a plan that lets them control their costs. BUSINESS BLUE HDHRA This is our plan. Business Blue SM High Deductible for Health Reimbursement Accounts
to consumer driven health care
high deductible health plans low cost health savings accounts affordable your guide to consumer driven health care flexible spending accounts no referrals univerahealthcare.com/employer I like saving money.
2016 Open Enrollment Presentation
2016 Open Enrollment Presentation Agenda Provider Changes Open Enrollment Information Compass Professional Health Services Explanation of each benefit plan Health Savings Accounts (HSA) Premiums Gallagher
SUMMARY OF MARYLAND STATE EMPLOYEES & RETIREES BEHAVIORAL HEALTH PLAN
SUMMARY OF MARYLAND STATE EMPLOYEES & RETIREES BEHAVIORAL HEALTH PLAN 2011-2012 Call APS Healthcare Toll-Free: 1-877-239-1458 Website: www.apshelplink.com Company Code: SOM2002 Year 2011-2012 Summary of
California Small Group MC Aetna Life Insurance Company NETWORK CARE
PLAN FEATURES Deductible (per calendar year) Unless otherwise indicated, the Deductible must be met prior to benefits being payable. All covered expenses accumulate toward the preferred and non-preferred
California Small Group MC Aetna Life Insurance Company
PLAN FEATURES Deductible (per calendar year) $5,000 Individual $10,000 Family Unless otherwise indicated, the Deductible must be met prior to benefits being payable. All covered expenses accumulate toward
Click this button to place your order.
2018 Medicare 35th Edition What you need to know about Medicare in simple, practical terms. Click this button to place your order. 2018 MEDICARE CONTENTS 1 2 3 4 5 6 Published By PAGE INTRODUCTION Are
F R E Q U E N T L Y A S K E D Q U E S T I O N S UnitedHealthcare Group Medicare Advantage PPO Plan
F R E Q U E N T L Y A S K E D Q U E S T I O N S UnitedHealthcare Group Medicare Advantage PPO Plan A. General Information About the UnitedHealthcare Group Medicare Advantage PPO Plan... 1 1. Why is Johnson
Medicare Insurance Guide. Help You Can Count On.
Medicare Insurance Guide Help You Can Count On. Help You Can Count On. For many people, Medicare alone does not provide a comprehensive safety net for health care expenses. While Medicare Parts A and B
Your Health Benefits 2016 Open Enrollment. October 2015
Your Health Benefits 2016 Open Enrollment October 2015 So why are we here? Sneak Peak for 2016 Open Enrollment No major plan changes this year Minor feature changes Focus on Health Investment Plan Education
SENATE, No. 551 STATE OF NEW JERSEY. 215th LEGISLATURE PRE-FILED FOR INTRODUCTION IN THE 2012 SESSION
SENATE, No. STATE OF NEW JERSEY th LEGISLATURE PRE-FILED FOR INTRODUCTION IN THE 0 SESSION Sponsored by: Senator NIA H. GILL District (Essex and Passaic) Senator JOSEPH F. VITALE District (Middlesex) SYNOPSIS
THIRD PARTY RECOVERY CLAIMS
CLAIMS ADJUSTMENTS AND RECOUPMENTS CHAPTER 11 SECTION 5 1.0. GOVERNMENT S RIGHT TO RECOVER MEDICAL COSTS The following statutes provide the basic authority for the recovery of medical costs incurred as
Medical Self-Funding Macro Trends
Medical Self-Funding Macro Trends Big picture economic trends impacting the future of self-funded medical plans. Phillip C. Giles, CEBS Vice President, Sales and Marketing Originally published in Captive
Understanding your health care costs.
Understanding your health care costs. What are copays? Copays are a fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. The amount can vary
CURRENT ISSUES WITH LIENS AND SUBROGATION CLAIMS
CURRENT ISSUES WITH LIENS AND SUBROGATION CLAIMS Franklin D. Patterson Patterson, Nuss & Seymour, P.C. 5613 DTC Parkway, Suite 400 Greenwood Village, CO 80111 Phone (303) 741-4539 Fax (303) 741-5043 FRANKLIN
Health Care Reform Information for Employees. Your options under health care reform
Health Care Reform Information for Employees Your options under health care reform Patient Protection and Affordable Care Act (PPACA) September 2013 Contents 1 Your options under health care reform 2 Health
Transparency and Communication: Avoiding Coverage Disputes Before the Claim is Filed CLM007
Transparency and Communication: Avoiding Coverage Disputes Before the Claim is Filed CLM007 Speakers: Mark S. Humphreys, Vice President/Litigation and Risk Management, Watt Companies, Inc. Thomas O. Myers,
A FIELD GUIDE TO MEDICARE
Make the most of Medicare. To learn more about Transamerica s Field Guide to Medicare series and to get support materials: Contact: Your Financial Professional Transamerica Resources, Inc. is an Aegon
Glossary of Terms. Adjudication: The way a health plan decides how much it will pay for certain expenses.
Page 1 Glossary of Terms Adjudication: The way a health plan decides how much it will pay for certain expenses. Affordable Care Act (ACA): The comprehensive health care reform law enacted in March 2010.
to consumer driven health care
high deductible health plans low cost health savings accounts affordable your guide to consumer driven health care flexible spending accounts no referrals univerahealthcare.com EXC_3206_UNIVERA_CONSUMER_BROCHURE.indd
2015 BENEFIT CHANGES FREQUENTLY ASKED QUESTIONS
Oct. 1, 2014 2015 BENEFIT CHANGES FREQUENTLY ASKED QUESTIONS Changes to The Hartford s 2015 Health Plan Options Consumer-Directed Health Plan (CDHP) Options Health Savings Accounts (HSA) Healthy Lifestyle
Mental health matters
Mental health matters Understanding mental health parity Aetna Behavioral Health Mental health makes up a big part of overall health. We believe mental health concerns should be treated like any other
Aetna Life Insurance Company Traditional Choice Plan
TC-1 Benefit Traditional Choice is an indemnity plan permitting freedom of choice of providers. Claim reimbursement is based upon reasonable and customary limits, rather than negotiated discounts. The
Medicare Advantage Explained 2008
Medicare Advantage Explained 2008 Getting More from Your Medicare Benefits An educational resource from 4 Medicare Basics 7 About Medicare Advantage 9 Medicare Advantage Options 12 Reviewing Your Choices
Government health care program fundamentals
Page 1 of 12 Government health care program fundamentals Guidelines for making well-informed decisions Table of contents 3 Medicare essentials 8 Department of Veterans Affairs Health Care Benefits Essentials
Some much anticipated guidance and some temporary relief, has been. Reimbursement Arrangement Guidance
Reimbursement Arrangement Guidance Written by Cori M. Cook, J.D. CMC Consulting, LLC Some much anticipated guidance and some temporary relief, has been received from the IRS recently in the form of Notice
Add Sizzle and education to your sales meetings! Tax Questions. Prepared by Paul McLaughlin, Legal Counsel
Broker Sales Meeting Packets Add Sizzle and education to your sales meetings! Tax Questions Prepared by Paul McLaughlin, Legal Counsel Iowa Association of REALTORS 1370 NW 114th Street, Suite 100 Clive,
January 1 December 31, 2013 Evidence of Coverage: Your Medicare Prescription Drug Coverage as a Member of Express Scripts Medicare
The Centers for Medicare & Medicaid Services (CMS) requires that we send you certain plan materials upon your enrollment in a Medicare Part D plan and annually thereafter. The enclosed Evidence of Coverage
Creating Effective Reinsurance Programs
Creating Effective Reinsurance Programs The Importance of Optimizing Clinical and Financial Outcomes Thomas D. Sass Chief Marketing Officer Presidio Reinsurance Group, Inc. Providing innovative, quality
ALLIANCE HMO WITH HRA MEDICAL PLAN
ALLIANCE HMO WITH HRA MEDICAL PLAN What is the Plan? This is a health plan that offers access to physicians selected based on their ability to guide their patients to the care and resources that help promote
Medicare 101. Understanding Your Options
Medicare 101 Understanding Your Options Futurity First is an independent, nationwide insurance and investment organization operating a network of community-based offices that specialize in retirement income
Medicare Coverage of Kidney Dialysis & Kidney Transplant Services
C E N T E R S F O R M E D I C A R E & M E D I C A I D S E R V I C E S Medicare Coverage of Kidney Dialysis & Kidney Transplant Services This official government booklet explains: The basics of Medicare
The Limited Liability Company Guidebook
The Limited Liability Company Guidebook Copyright 2017, Breglio Law Office, LLC Breglio Law Office 234 E 2100 South Salt Lake City, UT 84115 (801) 560-2180 admin@bregliolaw.com Thanks for taking some time
Health Care Program as of 7/01/08 (Please check back for updates)
Health Care Program as of 7/01/08 (Please check back for updates) Health Care Sessions Reasonable and Customary There seem to be different benchmarks for determining what charges are reasonable and customary.
Manage Your Life Insurance Policy
Take Charge of Your Future: Manage Your Life Insurance Policy Maximize the value of the life insurance policy you already own www.burdettedirect.com burdette Your Life Insurance Policy Is a Valuable Asset
Your AARP Personal Guide to Buying Health Insurance. What you should know. BA9802 (3/06)
Your AARP Personal Guide to Buying Health Insurance What you should know. BA9802 (3/06) A word from AARP Health Care Options AARP Health Care Options is happy to offer you this personal guide to buying
Simple answers to health reform s complex issues facing every employer, and what you can do now to protect your business and your future.
Simple answers to health reform s complex issues facing every employer, and what you can do now to protect your business and your future. If you have any questions, please contact: Health Reform: A Guide
Controlling Medical Costs in Self-Funded Employer Benefit Plans
Controlling Medical Costs in Self-Funded Employer Benefit Plans May 2017 Rick Franklin CLU, RHU, REBC CEO Frates Benefit Administrators Employers that offer health benefits to their employees through self-funded
UnitedHealthcare Choice Plus. United HealthCare Insurance Company. Certificate of Coverage
UnitedHealthcare Choice Plus United HealthCare Insurance Company Certificate of Coverage For the Definity Health Savings Account (HSA) Plan 7PC of East Central College Enrolling Group Number: 711369 Effective
Summary Plan Description
Summary Plan Description UNITEDHEALTHCARE HEALTH REIMBURSEMENT ACCOUNT PLAN FOR Tulane University Effective: January 1, 2014 Group Number: 755807 Notice To Employees HEALTH REIMBURSEMENT ACCOUNT (HRA)
Medicare 101. Understanding Your Options
Medicare 101 Understanding Your Options Futurity First is an independent, nationwide insurance and investment organization operating a network of community-based offices that specialize in retirement income
Welcome to BorgWarner!
Welcome to BorgWarner! We are excited to begin sharing the many benefits of belonging to BorgWarner. This Preview of the medical plans is just one of a series of communications you ll receive throughout
Human Resources Development Compensation and Benefits Retiree Medical Insurance Plan (RMIP) Update
Human Resources Development Compensation and Benefits Retiree Medical Insurance Plan (RMIP) Update October 16, 2014 Agenda Introductions Medicare Enrollment Overview Medicare Enrollment Requirement Reimbursement
Statement of Jennifer Wittney Horton - June 16, to take a close look at rescission so that it can understand just how damaging this practice
Statement of Jennifer Wittney Horton - June 16, 2009 Good morning ladies and gentleman. I want to start by thanking the Committee for this opportunity to testify this morning. I am very pleased that Congress
Your Rights and Responsibilities
Your Rights and Responsibilities 1-877-633-7943 24 hours a day/365 days a year TTY users dial 711 MGRX_18_WEBSITERIGHTSRESP SECTION 1 Our plan must honor your rights as a member of the plan ec 1.1 e must
Health Plan Payments to Non-Contracted Providers. James F. Doherty, Jr. Pecore & Doherty, LLC Columbia, Maryland
Health Plan Payments to Non-Contracted Providers James F. Doherty, Jr. Pecore & Doherty, LLC Columbia, Maryland Introduction Payment disputes between heath plans and their contracted health care providers