Telehealth has been a growing point of emphasis in U.S. health care discourse, as health care providers look to leverage interconnectivity to treat patients from a distance and legislators seek new ways to improve care. In the past year, new state and federal regulations have cleared the way for telehealth programs to thrive in a [...]

As organizations begin to assess options for group health coverage in 2018, new data out this week could help provide some perspective. Employer premiums on health care plans rose higher this year than they have in the past five years.... Additionally, self-funded plans...are also becoming more prevalent...[and] are becoming increasingly desirable to employers.... READ MORE

Reference-based pricing (RBP) is a fast-growing alternative to the PPO systems self-funded employers have utilized for their group benefit plans over the past 30 years.... As the PPOs started to build larger networks and attempted to bring costs down, they met resistance from key providers.... there were no regulations on what hospitals could bill for [...]

In preparing for the year ahead, the Society of Professional Benefit Administrators (SPBA) has released its State of the TPA Industry & Forecast for 2018. Fred Hunt, SPBA’s active past president, has been writing this report annually for the past 37 years.... As with years past, the 2018 Forecast shares a candid perspective on current [...]

Small and midsized companies are increasingly providing their own health coverage for employees instead of buying fully insured plans .... As the Affordable Care Act drives up premiums because of more requirements and taxes, self-insurance has become a more attractive option because it is often less expensive than purchasing fully insured plans.... But some policy [...]

Small employers are facing formidable hurdles as they consider self-funding health insurance plans. But self-funding still holds appeal.... Increasing regulation of self-funded health plans is complicating the efforts of some employers as they seek an alternative to plans offered under the Affordable Care Act, one analyst says. Most of the stiff regulation involves stop-loss, the [...]

When it comes to healthcare plan administration, ASOs (administrative services only) say they offer a big discount to self-funded plans. If you look closer, however, you’ll see that they actually do come with a cost, both monetarily and in terms of lack of flexibility.... Here are five benefits of working with a TPA... READ MORE

In some cases, plain words supported by facts carry the greatest impact. This was the case with the recent testimony provided by SPBA past Board of Directors member, Mary Smith, of Insurance Management Administrators, before the U.S. Department of Labor’s ERISA Advisory Council. Smith proved the point that... READ MORE

SFS News Release: Non-Traditional Health Benefits are the Focus of New Piece in Self-Funding Series - Continuing to expand its collection of educational resources, the Self-Funding Success website has published another piece related to the benefits of self-funding. This latest resource explores the more non-traditional health benefits being implemented today and how they are saving plans [...]

ERISA is very clear that the Plan Administrator is required to administer benefits strictly in accordance with the terms of the applicable plan document. Plan Administrators, though, are often faced with difficult situations – situations where paying a claim that might otherwise be excluded under the plan document would avoid considerable headache, appease a member [...]