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Showing results for tags 'self-funded'.
Found 4 results
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I am at a loss on this, in-network provider successfully sued patient for balance bill in state court despite denial of benifits with non-liabilty and both appeals being adminstratively denied for improper billing with non-liabilty of enrolle. Lawsuit was for breach of oral contract but the written ERISA contract had a hold harmless, and included language to prevent any form of out of network contract unless the provider informed the patient in writing services would not be covered under the plan (they did not). The judge ruled as if patient had insurance and would not correct to state it was Self-Funded ERISA, would this be a cause? -
(Sorry, I posted this in "other kinds of welfare benefit plans" as well, but I'm not sure that's the right place for it. So I'm posting it here as well.) Stumbled on this forum, what a great wealth of wisdom! I'm a union rep and we are considering starting a healthcare plan for our members. Instead of the various employers having their own healthcare plans for our members, the employers are going to give us the money and we will provide the healthcare plan for our own members. I believe we will need to start a VEBA and a MEWA, but I am uncertain as to how much we will need to allocate for start-up costs (e.g. legal advice, documents, etc.). We have 10-15k local union members. I'm assuming it will cost $500-$1mm to start up and at least 1.5 years before we can go live. Am I even in the ballpark? Anyone know how much it will cost us to get this started? Any help is much appreciated!
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Stumbled on this forum, what a great wealth of wisdom! I'm a union rep and we are considering starting a healthcare plan for our members. Instead of the various employers having their own healthcare plans for our members, the employers are going to give us the money and we will provide the healthcare plan for our own members. I believe we will need to start a VEBA and a MEWA, but I am uncertain as to how much we will need to allocate for start-up costs (e.g. legal advice, documents, etc.). We have 10-15k local union members. I'm assuming it will cost $500-$1mm to start up and at least 1.5 years before we can go live. Am I even in the ballpark? Anyone know how much it will cost us to get this started? Any help is much appreciated!
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Any insight on whether sponsors of self-funded health plans are sharing in rebates paid to the TPA when specialty drugs are run through the medical benefit instead the pharmacy program? We are capturing the rebates paid to the PBM when run through pharmacy benefit.
