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Self-Funded Health Plans: Plan Administration

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Course

Take control of your self-funded health plan with our comprehensive eLearning course on plan administration. This course covers the critical aspects of managing a self-funded health plan, from plan design to compliance with federal laws like ACA, COBRA, and HIPAA. Learn about essential administrative tasks, including enrolling participants, processing claims, maintaining records, and ensuring timely compliance with reporting requirements. Explore options for in-house administration versus third-party services and understand how to manage vendor relationships. Equip yourself with the skills to effectively administer a self-funded health plan and support the financial health of your organization.

Topics Covered

  • Plan Administration and Management
  • In-House Administration vs. Third-Party Administration
  • Legal and Regulatory Compliance
  • Vendor Management
  • Reporting and Documentation

Course Outline

View course outline

Introduction

  1. Introduction to Self-Funded Plan Administration
  2. Plan Sponsors and Employers
  3. Plan Participants and Beneficiaries

Estimated Time to Complete: 5 minutes

Plan Administration Options

  1. Plan Administrators
  2. In-House Administration
  3. Administrative Services Only (ASO) Arrangement
  4. Third-Party Administrators (TPAs)
  5. Comparing and Contrasting In-House Administration, ASO Arrangements and TPAs

Estimated Time to Complete: 30 minutes

Common Administrative and Compliance-Related Tasks

  1. Maintaining Compliance With Federal Laws
  2. Enrolling and Disenrolling Plan Participants
  3. HIPAA Special Enrollment
  4. Collecting and Tracking Plan Contributions
  5. Processing Claims
  6. Timely Processing
  7. Denying Claims
  8. Claims Appeals
  9. Recordkeeping
  10. Form 5500
  11. Participant Communication
  12. Common Documents That Must Be Distributed to Plan Participants
  13. Administrative Requirements of HIPAA
  14. COBRA Administration
  15. Reporting and Paying the Annual PCORI Fee

Estimated Time to Complete: 60 minutes

Types of Service Providers

  1. Plan Sponsor and Plan Administrator Responsibilities Regarding Service Providers
  2. Types of Service Providers
  3. Attorneys
  4. Actuaries
  5. Accountants
  6. Investment Manager and Advisors
  7. Custodians and Directed Trustees
  8. Benefits Consultants
  9. Stop-Loss Insurance Carriers
  10. Pharmacy Benefit Managers (PBMs)

Estimated Time to Complete: 45 minutes

Selecting and Monitoring Service Providers

  1. Selecting the Service Provider
  2. RFP Process
  3. Key Considerations When Implementing a New Vendor Relationship
  4. Monitoring the Vendor
  5. Changing a Vendor

Estimated Time to Complete: 30 minutes

NOTE: The estimated time to complete each lesson is based on word count and assumes uninterrupted consumption of the course. Actual time to complete each lesson can vary widely based on familiarity with the topics and other factors. Time required to complete the course final exam is not counted in these estimates.

Course Applies To

Three-Credit Course

US$195.00

Member

US$285.00

Nonmember

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Questions?

Contact us at (888) 334-3327, option 3 or [email protected].

Why Choose E-Learning?


Self-Paced
Navigate the course at a pace that fits your learning style.


Convenient
Learn on your schedule—without the inconvenience of time away from the office.


Expert-Created Content
Take a deep-dive into a topic with content developed by industry leaders.


Cost-Effective
Save when you choose affordably-priced training with no additional travel costs.