Highlight Health helps plan sponsors and their managers fulfill their fiduciary responsibilities and maintain fiduciary compliance.
Self-funded health plan sponsors are fiduciaries, which means they have specific duties and a special status under the law. If a self-funded health plan sponsor or its plan managers do not fulfill these duties, they can be subject to liability. Although ERISA is often cited when explaining health plan sponsor fiduciary duties for private employer-sponsored and union-sponsored plans, self-funded health plan managers for non-ERISA plans (for example, plans sponsored by governments, government subdivisions, tribal governments, and churches) have very similar fiduciary duties.
There is a rising trend of lawsuits being filed against self-funded health plan sponsors and their plan managers for failure to exercise appropriate fiduciary duty. As a result, plan sponsors are now under greater scrutiny regarding their fiduciary duties, yet many sponsors continue to be unaware of how to fulfill their duties and protect themselves from liability.
Plan Document Adherence
Health plan fiduciaries must follow the terms of plan documents to the extent that the plan terms are consistent with ERISA (or other legislation for non-ERISA plans). Highlight Health’s cost reduction strategies are based on existing statutes, laws, and regulations, and are easily enabled with activating plan document language that we provide.
Plan Document Services
Our experts will review your current plan documents and recommend modifications to ensure that your plan is properly operating at peak performance and incorporating proper payment integrity and cost containment.
We will also review your administrative service and network agreements to assure that your administrative service provider is protecting your interests and that none of your contracts contain prohibited “gag clauses” that prevent transparency and disclosure of healthcare pricing.
Compliance Drives Savings
The exercise of sound fiduciary duty reduces the cost of claims and saves plan sponsors money! It’s not simply another compliance drain on the plan sponsor’s limited resources. Highlight Health’s shared savings fees, which are contingent on our clients’ success, assure a return on your investment.