Self-Insured

Most medium- to large-sized employers in the U.S., including public and private companies, Taft-Hartley plans, the federal government, state governments and school boards, have self-insured health plans.  By definition, these plans…

• Rely on internal controls and business practices of a Third-party Administrator  (TPA) and Pharmacy Benefits Manager (PBM) or Dental Plan Manager (DPM).
• Cede policy decisions and procedures to a third-party(ies)
• Unfortunately, some self-insured employers assume that their fiduciary responsibility is satisfied by third-party involvement.  However, such is not the case.

The fact is, selecting an administrator does not relieve the self-insured employer of the responsibilities of accurate claims processing and financial reporting. Internal controls, system updates and modifications, plan design, discounts, medical management, eligibility...all ultimately impact your ability to accurately report quarterly and annual health plan expenses.

Public companies have the added compliance requirements of the Sarbanes-Oxley Act of 2002, as well as ongoing fiduciary responsibility to employees and shareholders.

Administrator Business Practices
Your ability to predict expenses and mange costs is definitely impacted by your administrator's business practices.  In fact, as administrators upgrade and modify business systems and practices, the risk of reporting and processing accuracy issues increases.

Administrator Internal Controls
The adequacy of your administrator's internal controls can have major implications for your financial stability.
With HDM's services – BenefitsAudit, BenefitsWatch – and our specialized audits, you can have the confidence of knowing how well your administrators are meeting their responsibilities. You can also be assured that your health plan is operating cost effectively, and that you are meeting your fiduciary responsibility as a self-insured employer.