Health Benefit Plan Basics
Topics Covered
- History and evolution of health benefit plans
- Plan models
- Managed care definitions and designs
- Plan financing
- The legal environment
- Carve-outs
- Retiree medical coverage
- Resources
- Case study
Course Outline
Day 1
- Introduction
- History and Evolution of Health Benefit Plans
- Health insurance as an employee benefit
- Causes and catalysts of health care inflation
- Relationship between health behavior and cost
- Plan Models
- Major medical terminology
- Coordination of benefits
- Managed Care—Definitions and Design
- HMO, PPO, POS, EPO, QHDHP, FSA, HSA, HRA
- Indemnity
- Consumer-driven health care
- Plan Financing
- Fully insured, self-funded, self-funded plus variations
- Contribution formula
- The Legal Environment
- Federal legislative and compliance agenda
- IRS, DOL, CMS, DHS
- Federal laws: ERISA, COBRA, HIPAA, FMLA, MPHA, MHPAEA, QMCSO, USERRA, PPACA, No Surprises Act
- Legal compliance and tax implications
- Summary of benefits and coverage documents
Day 2
- Carve-Outs
- Pharmacy benefits and Rx drugs
- Worksite wellness and incentives
- Behavioral health management and mental health
- Retiree Medical
- Plan design
- Medicare and Medicaid
- Employer considerations for retirees
- Resources With an Expanded Appendix of Reference and Resource Tools
- Case Study
The case study is a review and analysis of an independent audit performed by the Department of Labor (DOL). Groups will look at the new funding method and managed care for a benefit plan and will redesign the current benefit plan and discuss how and why the new plan provisions are being recommended.
Course Applies To
April 27 - 28, 2026
Hilton Scottsdale Resort & Villas,
Scottsdale, AZ
Pricing
Through March 16, 2026
US$1,495.00
Member
US$1,715.00
Nonmember
After March 16, 2026
US$1,795.00
Member
US$2,015.00
Nonmember
October 2 - 3, 2026
Caribe Royale Orlando,
Orlando, FL
Pricing
Through August 17, 2026
US$5.00
Member
US$8.00
Nonmember
After August 17, 2026
US$10.00
Member
US$12.00
Nonmember
Continuing Education
Educational sessions at this program can qualify for CEBS Compliance credit. Visit www.cebs.org/compliance for more information.
Agenda
Monday, April 27 - Tuesday, April 28, 2026
Hilton Scottsdale Resort & Villas, Scottsdale, AZ
8:00 AM - 5:00 PM
8:00 AM - 3:00 PM
Friday, October 2 - Saturday, October 3, 2026
Caribe Royale Orlando, Orlando, FL
6:00 AM - 3:00 PM
6:00 AM - 1:00 PM