The No Surprises Act: A Cost Saving Opportunity for Employer Plan Sponsors
Our lives are the sum of our choices, at least that is what the trailer for the next Mission Impossible moving is telling me. When I was a kid, I would read these Choose Your Own Adventure books where the story and outcome...more
I was very lucky that when I started as an ERISA attorney in 1998, I worked as a staff attorney for a third-party administrator (TPA). It gave me insight and experience that I could never have gotten as an attorney working...more
Recordkeepers and Third Party Administrators (TPAs) need to either scale up or innovate. The trend of consolidation in the TPA industry makes it increasingly difficult to compete against larger firms....more
At work and at home, one of the worst things I ever did was make a mistake and not accept responsibility for it. Instead of owning up, I would make excuses, turning the fight over the mistake into a bigger issue than the...more
As I have always said, the most important 401(k) plan provider you can hire is a Third-Party Administrator (TPA). That’s because a TPA does so much work, and their incompetence can lead to you getting penalized or forcing you...more
Friday, I was supposed to attend the New York Comic Con for a special session since I had a wholesale account with the leading comic book distributor. I’m sure the breakfast would have had some free giveaways and I was...more
As a plan fiduciary, I still can’t believe it. A Third Party Administrator (TPA) we terminated was trying to hold us up for valuations and a Form 5500 we paid for, as part of, annual administration. It was $80,000....more
“A lot of holes in the desert, and a lot of problems are buried in those holes. But you gotta do it right. I mean, you gotta have the hole already dug before you show up with a package in the trunk. Otherwise, you’re talking...more
The Kansas Insurance Department (“Department”) recently issued a Data Call to all Third Party Administrators (“TPAs”) licensed in the state of Kansas. Pursuant to the Data Call, the Department has requested information...more
The MTV reality series The Real World ended their opening intro with “to find out what happens… when people stop being polite… and start getting real.” As an ERISA attorney working with retirement plan clients, I often find...more
When I was a kid in day school in Brooklyn, we had a classmate whose shtick was that he was rich. He wasn’t rich, his father was a pa- thologist who worked at a city hospital, his mother didn’t work, and they rented a nice...more
Our “health plan hygiene” series has focused on steps that fiduciaries of employer-sponsored group health plans can take to ensure they meet their fiduciary responsibilities. This issue has been brought to the forefront...more
A health plan’s fiduciaries are responsible for administering the health plan. Because most employers are not in the business of administering health benefits, they outsource the day-to-day health plan administration to a...more
On September 12, the IRS reminded plan sponsors to review and comply with IRS Notice 2024-02 (the “Notice”), which extended and consolidated deadlines for employers and others sponsoring 401(k), 403(b), 457(b) and other...more
When I was at law school, I was the editor-in-chief of the law school’s newsmagazine. My rise to the top probably had a lot to do with the free time I had by not making law review or any other of the law journals. I failed to...more
What makes a good retirement plan financial advisor? Well, it takes attention to detail, an understanding of what the role to entails, and dedication to the client. In addition, what I find is the way a good financial advisor...more
Earlier this month, a Mayo Clinic employee filed a proposed class action against the clinic, arguing that the clinic’s employee health plan and its third-party administrator (TPA) Medica, underpaid for services performed by...more
In the United States, mental health (“MH”) and substance use disorder (“SUD”) (collectively “MH/SUD”) have continued to represent areas of intense concern. During the COVID-19 pandemic, the MH struggles of essential workers...more
The South Dakota Division of Insurance (“Division”) recently took regulatory action against a Texas-based Third Party Administrator (“TPA”) regarding its activities in South Dakota. According to the Division, the TPA...more
The U.S. Department of Labor (“DOL”) recently entered into a settlement agreement with a New York-based insurer and third-party administrator (“Company”) of employer group health plans governed by the Employee Retirement...more
Benefits costs continue to increase globally, and in the midst of high inflation and potentially a recession, executives are exploring cost effective methods to manage their self-insured health plans without compromising the...more
The U.S. Department of Labor (“DOL”) recently filed a lawsuit against UMR, Inc., a third-party administrator and UnitedHealth Group, Inc. subsidiary. The lawsuit alleges that UMR denied thousands of claims based on diagnosis...more
The Louisiana Insurance Department (“Department”) recently fined Express Scripts Administrators, LLC (“ESA”) $275,000 and MedImpact Healthcare Systems, Inc. (“MedImpact”) $250,000 for allegedly failing to pay electronically...more
If you work for or represent group health plans or issuers of group health plans, it is important that you take a look at the contracts they have with health care providers before the end of 2023. The Internal Revenue Code...more
Pharmacy Benefit Managers (PBMs) take note! Under Florida’s new Prescription Drug Reform Act, PBMs must be licensed as an insurance administrator (also known as a third-party administrator, or TPA). Under this new law, any...more