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OnDemand Course

Evaluating Your Third-Party Administrator: Are You Getting What You're Paying For?

Avoid regulatory and other pitfalls while ensuring every aspect of a successful benefit plan is being handled.

Many employers - both private and municipal - offer benefit programs to their employees, focusing on maximizing the benefit offerings while minimizing the associated costs. To aid them in structuring and administering these programs, they secure the services of a third-party administrator. Such third-party administrators (TPAs) strive to deliver administrative services in accordance with their service agreements but also make efforts to avoid taking on a fiduciary role or offer guidance beyond that which they are contractually obligated to provide. Some fall short of even this benchmark, failing to deliver and exposing their clients (and themselves) to legal liability, whilst others go above and beyond - creating exceptional value for their clients. This information will enable any and all entities responsible for identifying, selecting, and monitoring their TPA to track performance and assess results, as well as identify opportunities to create additional value in collaboration with their TPA. The material will explain how to avoid regulatory and other pitfalls while ensuring every aspect of a successful benefit plan is being handled.

88 minutes
Course Exam
Certificate of Completion
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Why Lorman?

Over 37 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

Agenda

Introductions

  • Speakers
  • Industry Involvement

Third-Party Administrators

  • Industries (Where Are TPAs Used?)
  • Dynamic
    • Affiliation
    • Network
    • Claims Process
    • InHouse vs. Subcontractors
  • Industry Trends (Growth and Characteristics)

TPA Benefits

  • Scenarios Where the TPA Added Value
  • Data
    • Types
    • Uses
  • Customization - the Good

TPA Pitfalls

  • Recent Cases Involving Conflicts and Mistakes
  • Issues for Which There Is No Recourse
    • Alignment vs. Conflict With StopLoss
  • Customization - the Bad

TPA Assessment and Monitoring

  • Reviewing the ASA
    • What to Look for
    • Right to Audit
  • Reports
    • Type of Info TPAs Should Share

TPA Communication

  • What a TPA Does
  • What a TPA Does Not Do
  • What the Client Needs to Communicate

Other Entities Involved

  • Insurance
  • Vendors
  • Brokers
  • Employer
  • Employees
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Why Lorman?

Over 37 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

Credits

OnDemand Course

Applications have not yet been submitted for Delaware, Idaho, Kentucky, Maine, Ohio, Oklahoma, South Carolina, and Wyoming CLE for this course. However, if you are interested in obtaining CLE for any of the listed states or have any additional credit questions please email us at [email protected] or call us at 866-352-9540.

This course was last revised on May 26, 2021.

Call 1-866-352-9540 for further credit information.

  • ASA 1.25
     
  • This program qualifies for 1.25 continuing education hour(s) towards maintaining your ASA credential. Please contact ASA for more information at [email protected]. Please retain proof of attendance in the event your CE record is audited.
     
  • AK CLE 1.5
     
  • Alaska attorneys may receive 1.5 hours of continuing legal education for completing this program. Please contact the Alaska Bar Association or go to www.alaskabar.org for details regarding reciprocity with other states.
     
  • AL CLE 1.5
     
  • This course or a portion thereof has been approved by the Alabama State Mandatory Continuing Legal Education Commission for a maximum of 1.5 hours credit.
     
  • Arizona CLE 1.5
     
  • The Arizona State Bar does not pre-approve or pre-certify MCLE programs. However, records of this program and attendance will be maintained by Lorman Education Services for auditing purposes. This activity may qualify for up to 1.5 hours toward your annual CLE requirement for the State Bar of Arizona.
     
  • CA MCLE 1.5
     
  • Lorman Business Center, LLC. is a State Bar of California approved MCLE sponsor and this course qualifies for 1.5 CLE hours of participatory credit.
     
  • CT CLE 1.0
     
  • Neither the Connecticut Judicial Branch nor the Commission on Minimum Continuing Legal Education approve or accredit CLE providers or activities. This course has been approved for CLE credit in jurisdictions aside from CT and therefore it automatically meets the content and delivery requirements in Connecticut. Credit is based on a 60 minute credit hour and shall be awarded as follows: 1.0 CLE credit(s).
     
  • GA CLE 1.0
     
  • This program has been approved by the Georgia Commission on Continuing Lawyer Competency for 1.0 CLE hours.
     
  • MO CLE 1.8
     
  • This course qualifies for self-study CLE credit in Missouri.
     
  • RI CLE 1.5
     
  • This program has been approved by the Rhode Island Mandatory Continuing Legal Education Commission for 1.5 hours of CLE credit.
     
  • VT CLE 1.5
     
  • This self-study program has been approved by the Mandatory Continuing Legal Education Board of Vermont for 1.5 hour(s) of CLE credit. Please note: Attorneys may only claim 12 credits per compliance period in this format. This course is considered "Non-Moderated Programming without Interactivity".
     

To earn each credit Lorman offers through the OnDemand learning platform, you need to watch 100% of the program. Also, for certain credits you will need to fulfill additional requirements which will be displayed on the "credits" tab when viewing the course.

This program does NOT qualify, nor meet the National Standard for NASBA accreditation.

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Why Lorman?

Over 37 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

Faculty

Ron E. Peck, Esq.

Ron E. Peck, Esq.

The Phia Group, LLC

  • Executive Vice President and General Counsel; a member of The Phia Group, LLC since 2006
  • As an ERISA attorney with The Phia Group, an innovative force in the drafting of improved benefit plan provisions, handled complex subrogation and third-party recovery disputes, medical provider direct contracting and spearheaded efforts to combat the steadily increasing costs of health care
  • Considered to be one of the nation’s premier self-funded health plan consultants and health benefits attorneys; lecturing at and participating in many industry gatherings including but not limited to the National Association Of Subrogation Professionals (NASP), Society of Professional Benefit Administrators (SPBA), the Health Care Administrator’s Association (HCAA), and SIIA
  • Currently serves as The Phia Group’s Executive Vice President and General Counsel, and is also a dedicated member of SIIA’s Government Relations Committee
  • J.D. degree, Rutgers University School of Law; B.S. degree in policy analysis and management, Cornell University
Adam V. Russo, Esq.

Adam V. Russo, Esq.

The Phia Group, LLC

  • Co-Founder and Chief Executive Officer of The Phia Group LLC; an experienced provider of health care cost containment techniques offering comprehensive claims recovery, plan document and consulting services designed to control health care costs and protect plan assets
  • The Phia Group’s overall mission is to reduce the cost of health benefits through its recovery strategies, innovative technologies, legal expertise, and focused, flexible customer service
  • Frequent speaker and author on health care and employee benefits; participating in webinars, conferences, and seminars across the country
  • 2019 Chairman of the Board of Directors for the Self-Insurance Institute of America, Inc. (SIIA) and Massachusetts Association of Health Underwriters (MAHU) Board Member
  • Admitted to the Massachusetts Bar, the U.S. Court of Appeals for the First Circuit and the Supreme Court of the United States
  • J.D. degree, Suffolk University Law School; master’s degree in finance, Frank Sawyer School of Management at Suffolk University in Boston; undergraduate degree in political science and public relations, Suffolk University
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Why Lorman?

Over 37 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

All of your training, right here at Lorman

All of your training, right here at Lorman.

Pay once and get a full year of unlimited training in any format, any time!

  • OnDemand Courses
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  • State Specific Credit Tracker
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Product ID: 408563
Published 2021
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