Health Plan Contracts

[card]

Hi. Does anyone have an issues checklist they use in performing a legal review of administrative services contracts (BC, Kaiser, etc.) for self-insured health plans?

Thanks.

card

[GBurns]

Are you sure you really mean "legal review" or did you mean performance review or service offering review?

[Guest rfh3]

I don't have a checklist, but the usual areas of interest are the performance guarantees as suggested already. And look at indemnification and the standard for such, access to data (particularly after termination), venue and method of dispute resolution, bonding, insurance (e&o), also. From the employer side, claims administration, data access and dispute resolution are typically of the most interest. Find out what they are charging for UR, drug cards, etc. ( there is probably a commission in there somewhere).