Company Acting Like a TPA

[ABC]

In my quest to sell more insurance I have started to really take a look at the different options for a group to go individual.

Met with a few companies and sat through a few conferences.

This one company will set up an HRA or section 125 so the a small group can either pay the individual premium or at least get the tax break.

I thought the company was a TPA but they are not. They claim that they assist the client to administer these arrangements.

The firm tells the employer if the employee medical claims fall under the HRA a guidelines. This way the employer does not know what exactly the claim under the HRA is.

I think this company has truly found loop holes in the law to administer these arrangements .

If they were a true TPA I would feel alot better about working with them.

What do you think?

 

[leevena]

Are the advising or paying the claim? Anyone can "advise" on eligibility of claims. Quite honestly, telling someone which claims are eligible for the HRA is not very difficult.

 

[stuy119]

My first thought was that Madoff wasn't a licensed stock dealer either, and to beware.

And like Lee said, it's not tough to be an adviser of eligible expenses. There are 1-page docs that can handle that.

 

[ABC]

Good feedback

This company wants $12 per employee per month to assist the group on self administering an HRA.

I think $12 is high for not being a real TPA

Thoughts?

 

[leevena]

HRA and 125 administration, like other forms of administration, is useful for a variety of reasons; day to day administration cost, HIPAA liability to employer/employee, what if the screw-up a claim, etc.

Not knowing the company and it's "services", it would be difficult to say if you are getting a good deal at $12, but my guess is it might be a little on the high side. We use a variety of vendors, all about 20-25% less, but again, I don't know what services mean.

There are a number of vendors you could use, check them out first.