May 26 at 1:00 - 2:30 pm EST
Avoid regulatory and other pitfalls while ensuring every aspect of a successful benefit plan is being handled.
Many employers – both private and municipal – offer benefit programs to their employees, focusing on maximizing the benefit offerings while minimizing the associated costs. To aid them in structuring and administering these programs, they secure the services of a third-party administrator. Such third-party administrators (TPAs) strive to deliver administrative services in accordance with their service agreements but also make efforts to avoid taking on a fiduciary role or offer guidance beyond that which they are contractually obligated to provide. Some fall short of even this benchmark, failing to deliver and exposing their clients (and themselves) to legal liability, whilst others go above and beyond – creating exceptional value for their clients. This information will enable any and all entities responsible for identifying, selecting, and monitoring their TPA to track performance and assess results, as well as identify opportunities to create additional value in collaboration with their TPA. The material will explain how to avoid regulatory and other pitfalls while ensuring every aspect of a successful benefit plan is being handled.
- You will be able to define the role of a third-party administrator versus the role of their client.
- You will be able to explain how to maximize the value of a TPA relationship while avoiding conflict and loss.
- You will be able to identify which TPAs are doing their job, which are failing, and which go above and beyond.
- You will be able to review TPA performance, and whether your benefit programs are in good hands.
- Industry Involvement
- Industries (Where Are TPAs Used?)
- Claims Process
- In-House vs. Subcontractors
- Industry Trends (Growth and Characteristics)
- Scenarios Where the TPA Added Value
- Customization – the Good
- Recent Cases Involving Conflicts and Mistakes
- Issues for Which There Is No Recourse
- Alignment vs. Conflict With Stop-Loss
- Customization – the Bad
TPA Assessment and Monitoring
- Reviewing the ASA
- What to Look for
- Right to Audit
- Type of Info TPAs Should Share
- What a TPA Does
- What a TPA Does Not Do
- What the Client Needs to Communicate
Other Entities Involved
In Partnership With Lorman Business Center, LLC
The Phia Group, LLC
- Executive Vice President and General Counsel; a member of The Phia Group, LLC since 2006
- As an ERISA attorney with The Phia Group, an innovative force in the drafting of improved benefit plan provisions, handled complex subrogation and third-party recovery disputes, medical provider direct contracting and spearheaded efforts to combat the steadily increasing costs of health care
- Considered to be one of the nation’s premier self-funded health plan consultants and health benefits attorneys; lecturing at and participating in many industry gatherings including but not limited to the National Association Of Subrogation Professionals (NASP), Society of Professional Benefit Administrators (SPBA), the Health Care Administrator’s Association (HCAA), and SIIA
- Currently serves as The Phia Group’s Executive Vice President and General Counsel, and is also a dedicated member of SIIA’s Government Relations Committee
- J.D. degree, Rutgers University School of Law; B.S. degree in policy analysis and management, Cornell University
Adam V. Russo, Esq.
The Phia Group, LLC
- Co-Founder and Chief Executive Officer of The Phia Group LLC; an experienced provider of health care cost containment techniques offering comprehensive claims recovery, plan document and consulting services designed to control health care costs and protect plan assets
- The Phia Group’s overall mission is to reduce the cost of health benefits through its recovery strategies, innovative technologies, legal expertise, and focused, flexible customer service
- Frequent speaker and author on health care and employee benefits; participating in webinars, conferences, and seminars across the country
- 2019 Chairman of the Board of Directors for the Self-Insurance Institute of America, Inc. (SIIA) and Massachusetts Association of Health Underwriters (MAHU) Board Member
- Admitted to the Massachusetts Bar, the U.S. Court of Appeals for the First Circuit and the Supreme Court of the United States
- J.D. degree, Suffolk University Law School; master’s degree in finance, Frank Sawyer School of Management at Suffolk University in Boston; undergraduate degree in political science and public relations, Suffolk Universit
- AL CLE 1.5
- This course or a portion thereof has been approved by the Alabama State Mandatory Continuing Legal Education Commission for a maximum of 1.5 hours credit.
- AR CLE 1.5
- This course has been approved for 1.5 hours of CLE by the Arkansas CLE Board.
- Arizona CLE 1.5
- The State Bar of Arizona does not approve or accredit CLE activities for the Mandatory Continuing Legal Education requirement. This activity may qualify for up to 1.5 hours toward your annual CLE requirement for the State Bar of Arizona.
- CA MCLE 1.5
- Lorman Business Center, LLC. is a State Bar of California approved MCLE sponsor and this course qualifies for 1.5 CLE hours of participatory credit.
- CT CLE 1.5
- Neither the Connecticut Judicial Branch nor the Commission on Minimum Continuing Legal Education approve or accredit CLE providers or activities. This course has been approved for CLE credit in jurisdictions aside from CT and therefore it automatically meets the content and delivery requirements in Connecticut. Credit is based on a 60 minute credit hour and shall be awarded as follows: 1.5 CLE credit(s).
- HI CLE 1.5
- This program was approved by the Hawaii State Board of Continuing Legal Education for 1.5 CLE credit hours.
- IL CLE 1.5
- This course was approved for a total of 1.5 hours of MCLE Credit by the Illinois MCLE Board.
- ME CLE 1.5
- This course has been approved by the State of Maine Board of Overseers of the Bar. Lawyers who complete this course shall receive 1.5 hours of CLE credit under M. Bar R. 12.
- NH MCLE 1.5
- NH MCLE does not approve or accredit CLE activities for the NH Minimum CLE requirement. Lorman Education Services believes this course meets the requirement of NH Supreme Court Rule 53 and may qualify for CLE credit(s). Program Length: 90 Minutes.
- NJ CLE 1.8
- This program has been approved by the Board on Continuing Legal Education of the Supreme Court of New Jersey for 1.8 hours of total CLE credit.
- PA CLE 1.5
- This Distance Learning program has been approved by the Pennsylvania Continuing Legal Education Board for 1.5 hours of substantive law, practice and procedure CLE credit.
- RI CLE 1.5
- This program has been approved by the Rhode Island Mandatory Continuing Legal Education Commission for 1.5 hours of CLE credit.
- VT CLE 1.5
- This program has been approved by the Mandatory Continuing Legal Education Board of Vermont for 1.5 hours of CLE credit.
- WA CLE 1.5
- This program has been approved by the Washington State Board of Continuing Legal Education for 1.5 hours of Law & Legal Procedure credit.
- WI CLE 1.5
- This program has been approved by the Board of Bar Examiners for 1.5 hours for use toward the Wisconsin Mandatory CLE requirement.
- WV MCLE 1.8
- This program has been approved by the West Virginia State Bar MCLE Commission for 1.8 MCLE hours.
- HR Certification Institute 1.5
- This program has been approved for 1.5 (General) recertification credit hours toward aPHR(TM), aPHRi(TM), PHR®, PHRca®, SPHR®, GPHR®, PHRi(TM) and SPHRi(TM)recertification through HR Certification Institute® (HRCI®). For more information about certification or recertification, please visit the HR Certification Institute website at www.hrci.org.
- SHRM 1.5
- Lorman Education Services is recognized by SHRM to offer Professional Development Credits (PDCs) for the SHRM-CPSM or SHRM-SCPSM. This program is valid for 1.5 PDC(s) for the SHRM-CP or SHRM-SCP. For more information about certification or recertification, please visit www.shrmcertification.org.
- CPE 1.8 including Personnel/HR 1.8
- Lorman Education Services is registered with the National Association of State Boards of Accountancy (NASBA) as a sponsor of continuing professional education on the National Registry of CPE Sponsors. State boards of accountancy have final authority on the acceptance of individual courses for CPE credit. Complaints regarding registered sponsors may be submitted to the National Registry of CPE Sponsors through its web site: https://www.nasbaregistry.org/cpas/complaints. CPE Credit: Maximum Credit Hours: 1.8 each session (based on a 50 minute credit hour). You must attend at least 50 minutes to obtain credit. Field of Study: Personnel/HR for 1.8 hours. Prerequisite: basic knowledge of employee benefits. Level of Knowledge: Intermediate. Teaching Method: Seminar/Lecture. Advance Preparation: None. Delivery Method: Group Internet Based. Please refer to the information in this brochure for outline, course content and objectives. Upon completion of this course, you will receive a certificate of attendance. Final approval of a course for CPE credit belongs with each state's regulatory board. Please note: In order to receive CPE credit for this course you MUST use the streaming audio option, as well as enable and complete the required progress checks.