Course

Health Benefit Plan Basics

Today's competitive world places a high value on attracting and retaining global talent, especially in the current economic environment. Prospective and current employees need to look closely at employee compensation strategies and health benefit plans. This course provides the essential framework, knowledge, competencies and tools to evaluate and enhance existing plan designs. Using case studies and classroom interaction with peers, this two-day course presents a systematic way to evaluate how plans can remain robust and become a leading-edge total benefits program. Join your peers and experts to gain insight related to the latest legislative, regulatory and marketplace challenges that accompany health and welfare plan design and administration.

Topics Covered

  • History and evolution of health benefit plans
  • Plan models
  • Managed care definitions and designs
  • Plan financing
  • The legal environment
  • Carve-outs
  • Retiree medical coverage
  • Resources
  • Case study

Course Outline

View course outline

Day 1

  1. Introduction
  2. History and Evolution of Health Benefit Plans
    1. Health insurance as an employee benefit
    2. Causes and catalysts of health care inflation
    3. Relationship between health behavior and cost
  3. Plan Models
    1. Major medical terminology
    2. Coordination of benefits
  4. Managed Care - Definitions and Design
    1. HMO, PPO, POS, EPO, QHDHP, FSA, HSA, HRA
    2. Indemnity
    3. Consumer-driven health care
  5. Plan Financing
    1. Fully insured, self-funded, self-funded plus variations
    2. Contribution formula
  6. The Legal Environment
    1. Federal legislative and compliance agenda
    2. IRS, DOL, CMS, DHS
    3. Federal laws: ERISA, COBRA, HIPAA, FMLA, MPHA, MHPAEA, QMCSO, USERRA, PPACA, No Surprises Act
    4. Legal compliance and tax implications
    5. Summary of benefits and coverage documents

Day 2

  1. Carve-Outs
    1. Pharmacy benefits and Rx drugs
    2. Worksite wellness and incentives
    3. Behavioral health management and mental health
  2. Retiree Medical
    1. Plan design
      1. Medicare and Medicaid
      2. Employer considerations for retirees
  3. Resources With an Expanded Appendix of Reference and Resource Tools
  4. Case Study
    The case study is a review and analysis of an independent audit performed by the Department of Labor (DOL). Groups will look at the new funding method and managed care for a benefit plan and will redesign the current benefit plan and discuss how and why the new plan provisions are being recommended.

Course Applies To

Jul '25 Oct '25 Apr '26 Oct '26

Pricing

Through June 2, 2025

US$1,400.00

Member

US$1,620.00

Nonmember

After June 2, 2025

US$1,700.00

Member

US$1,920.00

Nonmember

Chicago, IL

Pricing

Through August 25, 2025

US$1,400.00

Member

US$1,620.00

Nonmember

After August 25, 2025

US$1,700.00

Member

US$1,920.00

Nonmember

Hilton Austin
Austin, TX

Pricing

Through March 16, 2026

US$1,495.00

Member

US$1,715.00

Nonmember

After March 16, 2026

US$1,795.00

Member

US$2,015.00

Nonmember

Scottsdale, AZ

Pricing

Through August 17, 2026

US$1,495.00

Member

US$1,715.00

Nonmember

After August 17, 2026

US$1,795.00

Member

US$2,015.00

Nonmember

Caribe Royale Orlando
Orlando, FL

Continuing Education

Educational sessions at this program can qualify for CEBS Compliance credit. Visit www.cebs.org/compliance for more information.

Agenda

July '25 October '25 April '26 October '26

Monday, July 14 - Tuesday, July 15, 2025

Chicago, IL

Wednesday, October 8 - Thursday, October 9, 2025

Hilton Austin, Austin, TX

8:00 AM - 5:00 PM

Health Benefit Plan Basics - Day 1

8:00 AM - 3:00 PM

Health Benefit Plan Basics - Day 2

Monday, April 27 - Tuesday, April 28, 2026

Scottsdale, AZ

The selected event has no sessions.

Friday, October 2 - Saturday, October 3, 2026

Caribe Royale Orlando, Orlando, FL

The selected event has no sessions.