ACPEN: Stop Loss & Contract Review: Protecting Your Plan and Your Bottom Line

Overview

Go in-depth to understand the three main components of self-funded plans: Stop Loss, Third Party Administrators (TPA), and Pharmacy Benefit Managers (PBM). This section will review both Specific and Aggregate Stop Loss as a concept while also providing in-depth knowledge of contract terms and risk management. It will discuss the key components of a TPAs/PBMS and show examples of admin agreements. The instructor will also use real world examples to show how to avoid common pitfalls and use cost savings tools to ensure that waste, fraud, and abuse are eliminated from your plan structures. The end of this unit will also introduce point solutions and how they can be used to ensure peak plan performance and claims savings.

Highlights

• Stop Loss
• TPA
• PBM
• Point Solutions

Prerequisites

None

Designed For

HR and Finance professionals

Objectives

• Stop Loss
• Third Party Administrative Structures
• The role of Pharmacy Benefit Managers
• Common plan design mistakes and how to avoid them
• Point Solution 101

Preparation

None