Forensics of a Medical Plan: Dissecting Health Benefits on a Company Level

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Xlibris Corporation, Jul 26, 2011 - Medical - 217 pages
The purpose of this book is to give information and the ability to understand and determine the pertinent facts as it relates to the analysis of Health Benefit Plans in transparency in costs and compensation with vendors in a Self-Funded Health Benefit Plan. This book will provide information on the analysis and understanding in each of the architectural structures of an employee benefit health plan and provide insight into the ability to question the presentations from Agents, Brokers and Consultants (ABCs) and CAs. There are many aspects to structuring, managing, and taking control of the Health Benefit Plan for the best outcomes in plan design, administration, controlling cost, and retaining dollars for the future of the employee benefits.
 

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Contents

Introduction
13
Types of Health Benefit Plans
15
Matrix of the Plan
17
Fiduciary to the Plan
28
Agents Brokers or Consultants
31
Role of the TPA
35
Choosing the Contract Administrator
38
Contract Administrator Agreements
42
Gathering Information
104
Requesting Reports
107
Accounting and Accounts
119
Bringing it all Together
128
Forensic Application
132
Forensic Decision and Dissection Mapping
157
The G Factor in Employee Benefits
166
Auditing Components of your Plan
173

Medical Stop Loss Also Know as Excess Insurance
61
Managed Care
68
Pharmacy Benefit Management
72
Prescription Benefit CarveOut
78
PPO Network Analysis
83
NonPAR or OON Repricing and Negotiation
88
Coordination Plan Document Stop Loss Agreement and PPO Agreement
93
ID Card Structure
100
Data Risk Analysis
102
Illegals and the Social Programs of the United States
178
Spread Sheeting FixedCosts versus Maximum Costs
182
The Benefit Delivery Using IRC Section 125
185
Questionnaire for Evaluation of Contract Administrator
192
About the Author
209
Acronyms Used in This Book
211
Bibliography
213
Index
215
Copyright

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