Frequently Asked Questions
01
Why use a TPA?
TPAs offer numerous benefits including expertise in managing benefits programs, ease of use, cost savings, more control and customization in plan design, knowledge of complex regulations and compliance, administrative support, access to technology, and personalized services.
02
Who can benefit from a TPA?
The versatility and expertise of TPAs make them valuable to a wide range of organizations and institutions. These include employers, insurance companies, self-insured entities, government agencies, healthcare providers, financial institutions, professional associations, and educational institutions.
03
What is a self-funded health insurance plan?
In this health insurance arrangement, employers assume the financial risk of providing benefits to their employees or members. Instead of paying a premium to an insurance carrier, the employer sets asides funds to cover the anticipated healthcare expenses of employees and their dependents.
04
What is stop loss insurance?
Stop-loss insurance provides protection to self-funded employers against large, unexpected claims by reimbursing them for claims expenses that exceed certain predetermined limits (stop-loss thresholds).
05
What is benefit plan design?
This involves the design, review, and ongoing management of employee benefit plans, including health insurance, dental coverage, vision plans, retirement benefits, and more. It may also involve periodic updates and enhancements to ensure that plans remain competitive and aligned with organizational goals.
06
How do TPAs provide risk management?
TPAs can identify, assess, and help mitigate risks associated with employee benefits programs. These risks include managing compliance risks, monitoring claims experience, and implementing risk mitigation strategies.
07
What are cost containment strategies?
These are methods to control healthcare costs such as utilization management programs, preferred provider networks, wellness initiatives, and negotiation of favorable pricing with healthcare providers and vendors.