This is a question a lot of people can relate to! For those of us who work closely with health plans, we know how many different documents there are to keep organized, consistent and up-to-date. We also know what kind of negative consequences can await if we don’t stay on top of them.
Cypress’s partner firm, The Phia Group, gave a great presentation on this topic at our last Cypress University, so I’ll touch on some of the key points speaker Tim Callender shared with us.
His main recommendation was to do a thorough gap review among health plan docs to compare and see where there may be any discrepancies. With so many docs in play – from summary plan descriptions and administrative service agreements to stop loss policies and plan amendments – it’s essential that the language used throughout matches up and definitions are kept the same. If one doc says one thing and another contradicts that, the problems can be significant – and expensive.
A few other best practices Tim addressed in his presentation:
- Get plan docs done earlier each year to avoid the last-minute rush and missed deadlines.
- Be sure partners (i.e. brokers, consultants, stop loss providers and TPAs) are familiar with and working together on the docs, set clear expectations for who does what and stay in communication with all partners on any changes, updates, etc.
- Share any docs/contracts with the people who are bound by them.
- Customize docs to fit a health plan instead of simply implementing a generic template that may not be applicable to the company.
- Spell out details like what’s considered medically necessary or experimental; specify exclusions.
- Incorporate amendments in a timely fashion.
Yes, it can definitely feel like a hassle to juggle so many health plan-related docs. But it’s an even bigger hassle – and possibly disastrous – when you don’t have the docs you need correctly completed, updated or shared with the appropriate people. Take the time to follow the best practices here and it can help you avoid some major problems down the road!