Claims Procedures for Self-Funded Health Plans, Health FSAs and HRAs

What to Do, What to Avoid, and How to Monitor Claims Administration

Available immediately

The DOL’s claims procedure regulations impose detailed requirements for health plans (including health FSAs and HRAs), and the courts are enforcing the rules. Whether you handle claims for your company’s self-funded plans or perform claims administration as a service provider for employer plans, you need to stay on top of how the rules are being interpreted. Join our experts for this 90-minute web seminar as they explain the best practices for health plan claims, especially how to make claim denials stand up in court.

Originally presented on February 26, 2009.

Seminar Level


Intermediate Difficulty

Topics Covered

Here’s some of what was covered:

  • Exactly what information has to be in the written claims notices? What information is most often missing or improperly explained? Does an Explanation of Benefits (EOB) meet the requirements?
  • How do the ERISA regulations apply to transactions that involve an electronic payment card? What rules apply when a health FSA or HRA reimbursement is tied to a major medical plan’s payment or denial?
  • What common mistakes are showing up in court cases that overturn plan denials?
  • Who must make claim decisions and what procedures must they follow? When must independent experts be consulted and what information must be given to the claimant about the expert?
  • What should you do if you discover a new reason for denial during the appeal process?
  • How can you determine whether your claims administrator is in compliance with the regulations? What should you do if it’s not in compliance?

Details

Speakers: Darcy L. Hitesman and Kyle T. Murray. Ms. Hitesman is an attorney and principal shareholder of Hitesman & Associates, P.A., in Minneapolis. She is a longtime Contributing Author of EBIA’s ERISA Compliance for Health & Welfare Plans manual. Mr. Murray is an attorney and Editor at EBIA. He is the Editor and a Contributing Author of EBIA’s ERISA Compliance for Health & Welfare Plans manual.

Handouts: A handout of the seminar slides and other information is provided through download.

Viewing Details

Accessing the recorded web seminar: After you purchase a recorded web seminar, you will receive an email with access information. You and your co-workers may then view the recording as many times as you wish for 60 days. An internet connection is required to view the recording; it can be stopped and started as needed and has a table of contents for easy navigation.

Recordings are accurate as of the date presented: Our recordings are accurate as of the presentation date of the live seminar. We supplement handout materials with articles from the EBIA Weekly covering significant later developments. You must check the table of contents at your access link for updates before viewing a recorded seminar.

Please respect our copyright: Do not record the web seminar, share the access link, or duplicate materials. For details on our copyright policy, please visit our Copyright page.

System Requirements for Recorded Web Seminars

EBIA uses WebEx technology for the seminar. You may wish to view system requirements, test your system and download any necessary WebEx software here:

http://www.webex.com/lp/jointest/

If you are not able to complete the WebEx installation, please contact WebEx technical support at (866) 863-3904.