This latest collaboration between the two long-time partners is aimed at helping Cypress’s employer-clients avoid the costly ramifications that can result from fiduciary-related benefit matters. It features PACE (Plan Appointed Claim Evaluator®) – a one-of-a-kind program from The Phia Group that assumes this fiduciary burden on behalf of employers. The program is unique to the industry and utilizes the firm’s legal expertise when benefit claims are denied and appeals are initiated.
Having this liability protection can be critical as self-funded employers are subject to fiduciary duty under the Department of Labor’s ERISA law. Their fiduciary responsibilities include paying claims in a nondiscriminatory manner and using plan assets appropriately. If any violations are cited, employers and plan sponsors can face costly civil and criminal penalties. PACE services are available for all types of self-funded plans, including captives.
“The PACE program fills a large gap for self-funded employers in situations that involve complicated claims decisions,” said Tom Doney, president and CEO of Cypress. “This resource takes the burden off of them and provides expert legal counsel that can save companies significant amounts of time and money.”
As part of the program, PACE provides Cypress clients with:
• Thorough review and revision of self-funded plan documents to ensure compliance
• Final internal appeals assessment and issuance of directives as a fiduciary
• Legal analysis of health claim decisions, clinical review and access to URAC-accredited Independent Review Organizations (IROs)
• Confidence that health claims are being processed according to a plan’s specific terms
• Review of stop loss policies and network contracts
• Coordination of administrative appeals and plan representation in the event of any lawsuits
• Financial protection from the lawsuits and/or damages that result from a fiduciary breach or stop loss denial
“The PACE program is easy to implement and it can give employers real peace of mind as far as potential fiduciary situations,” Doney said. “Throughout our partnership, The Phia Group has served as an instrumental legal resource, and we are confident that PACE will greatly benefit many clients in the years to come.”
About Cypress Benefit Administrators
A privately held company headquartered in Appleton, Wis., Cypress Benefit Administrators has been pioneering the way toward cost containment in self-funded health benefits since 2000. The third party administrator (TPA) is the country’s first to bring claims administration, consumer driven health plans and proven cost control measures together into one package for companies ranging from 50 employees to thousands of employees. It serves employer-clients across the U.S. with additional locations in Portland, Ore., Omaha, Neb. and Denver, Col. For more information on Cypress and its customized employee benefits, visit http://www.cypressbenefit.com.
Dave Willems, Willems Marketing & Events, +1 920.750.5013, [email protected]