Health Benefit Plan Basics Course Outline

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Today’s competitive world places a high value on attracting and retaining global talent, especially in today’s economic environment and post–COVID-19 times. Prospective and current employees are taking a keen eye to employee compensation strategies and, in particular, health plan benefits.  This cornerstone class provides the essential framework, knowledge and competencies for the attendee to have the tools to evaluate and enhance existing plan designs—especially in these challenging times. 

Using case studies and classroom interaction with peers, the course presents a systematic way to evaluate how plans can remain robust and be viewed as part of a leading-edge total benefits program.  In addition, the class provides insight related to the latest legislative, regulatory and marketplace challenges that accompany health and welfare plan design and administration. 

Day 1

  1. Introduction
  2. History and Evolution of Health Benefit Plans
    1. Health insurance as an employee benefit
    2. Causes and catalysts of health care inflation
    3. Relationship between health behavior and cost
  3. Plan Models
    1. Single employer vs. multiemployer
    2. Major medical terminology
    3. Ancillary benefits (vision, dental, life, disability)
    4. Coordination of benefits
  4. Managed Care—Definitions and Design
    1. HMO, PPO, EPO, POS, QHDHP, FSA, HSA, HRA
    2. Indemnity
    3. Consumer-driven health care
  5. Plan Financing
    1. Fully insured, self-funded, self-funded plus variation
    2. Credibility and underwriting
    3. Contribution formula
    4. Funding vehicles: General asset, trust, tax-exempt
    5. Risk management

 

Day 2

  1. The Legal Environment
    1. Federal legislative and compliance agenda
    2. IRS, DOL, CMS, HIS, DHS
    3. Federal laws: ERISA, COBRA, COBRA, HIPAA, FMLA, MPHA, MHPAEA, QMCSO, DOMA, GINA, USERRA, SCHIP, Michelle's Law, PPACA, No Surprises Act
    4. Legal compliance and tax implications
    5. Summary of benefits and coverage documents
  2. Carve-Outs
    1. Pharmacy benefits and Rx drugs
    2. Worksite wellness and incentives
    3. Behavioral health management and mental health
    4. EAP
    5. Long-term care
  3. Retiree Medical
    1. Funding
    2. Plan design
      1. Medicare and Medicaid
      2. Advantage plans
  4. Resources
  5. Case Study
    The case study is a review and analysis of an independent audit performed by the Department of Labor. 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.

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