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 keeping a keen eye on employee compensation strategies and 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. Major medical terminology
      2. Coordination of benefits

    4. Managed Care - Definitions and Design
      1. HMO, PPO, POS, EPO, QHDHP, FSA, HSA, HRA
      2. Indemnity
      3. Consumer-driven health care

    5. Plan Financing
      1. Fully insured, self-funded, self-funded plus variations
      2. Contribution formula

    6. The Legal Environment
      1. Federal legislative and compliance agenda
      2. IRS, DOL, CMS, DHS
      3. Federal laws: ERISA, COBRA, HIPAA, FMLA, MPHA, MHPAEA, QMCSO, USERRA, PPACA, No Surprises Act
      4. Legal compliance and tax implications
      5. Summary of benefits and coverage documents

Day 2

  1. Carve-Outs
    1. Pharmacy benefits and Rx drugs
    2. Worksite wellness and incentives
    3. Behavioral health management and mental health
  2. Retiree Medical
    1. Plan design
      1. Medicare and Medicaid
      2. Employer considerations for retirees
  3. Resources with an expanded Appendix of reference and resource tools

  4. 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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