When making the decision to self-fund, employers most often select a professional third party administrator (TPA) to manage this process.

It is important to remember that professional licensed TPAs are managing not only your plan assets, but they are writing out of your stop loss carrier’s check book for claims that go over your stop loss levels.  Things to consider when selecting your TPA are:

  • Claims system
  • EDI capabilities
  • Reporting capabilities
  • Years of service
  • Performance statistics
  • Flexibility
  • Ownership/conflicts of interest
  • Management and technical capabilities
  • Compliance standards and readiness
  • Customer service statistics
  • PPO and PBM relationships
  • Auditing procedures
  • Summary Plan Descriptions (SPD)
  • ID card production
  • Price

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