Network Adequacy

[Chaz]

Is the choice of a network by a plan sponsor of a self-insured plan a decision that is subject to ERISA's fiduciary requirements?

For example and theoretically, can a employer that has participants primarily living in Florida choose a TPA whose network contains primarily Idaho providers?

Or is this a settlor decision?

[leevena]

Is this a trick question? My initial reaction was that it is a settlor decision, which is in-line with what I have known over the years. But then I considered the network issue (floriday vs idaho) and thought to myself who in the world would create a network that requires most/all people to be out-of-network. And if such a design was created I would not be surprised if there was a lawsuit brought and I would not be surprised if the courts ruled against the plan.

Would be interested in hearing others opine.

[KJohnson]

Here is an article. Note the author...

https://publichealth.gwu.edu/departments/healthpolicy/DHP_Publications/pub_uploads/dhpPublication_3B1BC1E8-5056-9D20-3DBD5F020B65EED3.pdf

[Chaz]

and thought to myself who in the world would create a network that requires most/all people to be out-of-network.

This is most definitely a hypothetical which I created to pose a particularly extreme example.

[Chaz]

Here is an article. Note the author...

https://publichealth.gwu.edu/departments/healthpolicy/DHP_Publications/pub_uploads/dhpPublication_3B1BC1E8-5056-9D20-3DBD5F020B65EED3.pdf

Lots of good stuff in this article. Thanks!

[leevena]

Good article. Sorry, but the name does not mean anything to me, who is the author?

[GMK]

^if you're serious, google: Borzi

[leevena]

Saw that, sorry was focused in another direction. When I first read "note the author" I immediatly thought that it was going to be someone from this forum. Thanks.