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Junkman, we all have to start somewhere.
I started in the group business as a consultant right out of college. Had more book knowledge about insurance than any other rookie but lacked real world experience.
In my first job I had the opportunity to learn from a former group VP for a major carrier. He taught me everything he knew, including some of the tricks of the trade.
Along the way I was fortunate to work with and for some of the best people in this industry.
And all of that was when google was just an (almost) infinite number and Algore hadn't invented the internet.
I don't know if Jeff connected with Greg Browne or not but if he did he has a good one. Greg has been in the health insurance business almost as long as I have. If I were ever to get back in the group health business I would rely on Greg.
Even if Jeff doesn't land either one of those cases he will learn something. And if he works with Greg he will be learning from one of the best.
You'd better get some knowledge. Ignorance can get you in trouble. You can't simply ask professor Google for help.
I was "assigned" and contacted by someone else. So far he seems knowlegable and helpful.
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I am not simply relying on Google and/or this forum (though the forums are interesting and informative).
I am working with someone in the Atlanta office of BenefitMall. He has been very helpful and has answered my calls and Emails promptly. The lady that ran the quote has likewise answered my questions. I do have a lot to learn, but I am not afraid to say I don't know and then request help. I have, thus far, found BenefitMall to provide a good service.
scagnt83...There is no ERISA requirement, legal or otherwise, that requires the employer to shop the market and chose the best plan.
Group health insurance certainly does fall under ERISA. And if you dig down in the regulations they state that plan sponsors must do their due diligence in selecting a plan. According to previous court judgments, due diligence is considered weighing multiple options against each other. So you are correct that there is no specific law... but like most other aspects of ERISA, there are court cases that give us guidance on how to stay within what the regulators, aka the DOL, want plan sponsors to do.
How else would a Plan Sponsor prove their due diligence in selecting a Plan?
I am fully aware that group health falls under ERISA. What I am contesting is your statement that "the employer has a legal obligation to do their due diigence to shop the market and find the best option for the beneficiaries." This is simply not true. If you believe otherwise, and I will gladly eat some crow, site it for me.
You may be confusing this with the employer's fiduciary responsibility.
Fiduciaries have important responsibilities and are subject to standards of conduct because they act on behalf of participants in a group health plan and their beneficiaries. These responsibilities include:
- Acting solely in the interest of plan participants and their beneficiaries and with the exclusive purpose of providing benefits to them;
- Carrying out their duties prudently;
- Following the plan documents (unless inconsistent with ERISA);
- Holding plan assets (if the plan has any) in trust; and
- Paying only reasonable plan expenses.
Hiring A Service Provider
Hiring a service provider in and of itself is a fiduciary function. When considering prospective service providers, provide each of them with complete and identical information about the plan and what services you are looking for so that you can make a meaningful comparison.
Some actions fiduciaries need to consider when selecting a service provider include:
- When searching for a firm, get information from more than one provider;
- Compare firms based on same information – services offered, experience, costs, etc.;
- Obtain information about the firm itself: financial condition and experience with group health plans of similar size and complexity;
- Evaluate information about the quality of the firm's services: the identity, experience, and qualifications of professionals who will be handling the plan or providing medical services; any recent litigation or enforcement action that has been taken against the firm; and the firm's experience or performance record; ease of access to medical providers and information about the operations of the health care provider; the procedures for timely consideration and resolution of patient questions and complaints; the procedures for the confidentiality of patient records; and enrollee satisfaction statistics; and
- Ensure that any required licenses, ratings or accreditations are up to date (insurers, brokers, TPAs, health care service providers).
An employer should document its selection (and monitoring) process, and, when using an internal administrative committee, should educate committee members on their roles and responsibilities. Read, understand, and keep a copy of all contracts.