Plan Design & Partners

Your benefit plan document is the rulebook for every claim. Here are best practices for keeping it accurate, defensible, and aligned with your strategy.

Telemedicine services have gained massive popularity for their convenience and safety. Here’s how to screen a telemedicine provider that fits your self-funded plan.

With premiums escalating, employers must start managing per-employee-per-year (PEPY) cost performance. Here’s why PEPY is the benchmark that matters.

Eligibility audits by the numbers: how often ineligible dependents quietly drive up self-funded plan spend and what employers recover when they audit annually.

Not all group health plans are created equal. Plan design, network choice, and partner alignment separate the plans that control cost from those that don’t.

Plan documents by the numbers: what self-funded employers should look for in summary plan descriptions, stop loss policies, and TPA contracts.

A subrogation strategy recovers dollars that another responsible party should pay. Here’s how self-funded employers and captives build a plan that captures them.

Organ transplants by the numbers: volume, average cost, and what self-funded employers should know about preparing for these high-impact, high-cost claims.

Organ transplants are among the highest-cost claims any employer plan can face. Here’s how self-funded employers prepare with stop loss and centers of excellence.

Association health plans give small employers a path to group purchasing power. Here’s how they work and when self-funded captives offer a better fit.

Choosing a TPA is one of the highest-leverage decisions in a self-funded plan. Here are the tips employers use to pick the right partner.