EBIA Self-Insured Health Plans

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Written and edited by experienced employee benefits attorneys,EBIA Self-Insured Health Plans is the go-to resource for employers that sponsor self-insured health plans and their advisors. For employers considering self-insurance, it answers all of your questions about what self-insurance means, why employers choose to self-insure, and what challenges to expect when changing from an insured plan to a self-insured plan. From plan design through ongoing administration, our in-depth coverage, practical examples, tips, tables, checklists, and sample documents keep you informed, in compliance, and on top of new developments.
Topics include:

• Potential advantages of self-insuring
• Financial risks and the role of stop-loss insurance
• Plan design decisions - including networks, covered benefits, eligibility, and cost-sharing
• Governing law - including ERISA, the Internal Revenue Code, health care reform, COBRA, HIPAA, and other federal mandates - with analyses that highlight special issues for self-insured health plans
• Nondiscrimination rules
• Employer's fiduciary responsibilities
• Contracting with TPAs and other service providers
• Plan administration and compliance - including reporting and disclosure requirements, claims and appeals, and plan audits

This extensive resource offers the guidance you need to make smart financial and compliance decisions for your plan.

In addition, subscribers to the online edition will get access to primary source material including:

• ERISA
• ERISA History
• Advance Notices of Proposed, Interim & Final DOL Rules
• DOL Final Regulations and Interim Rules
• Preambles to DOL Final Regulations and Interim Rules
• DOL Proposed Regulations & Preambles
• Selected US Code Provisions
• Selected US Code Provisions History
• Selected Final Federal Regulations
• Preambles to Selected Final Federal Regulations
• Selected Proposed Federal Regulations & Preambles
• Other Selected Tax Documents & Releases
• ERISA Opinion Letters
• DOL Rulings & Releases
• Other Miscellaneous Nontax Releases
• Internal Revenue Code (1990 - present)
• Code History
• Final and Temporary Regulations
• Advanced Notices of Proposed Rulemaking & Treasury Decisions
• Prior Final and Temporary Regulations (Treasury Decisions)
• Preambles to Final and Temporary Regulations (Treasury Decisions)
• Preambles to Proposed Treasury Regulations (Treasury Decisions)
• Prior Proposed Regulations & Preambles
• Proposed Regulations and Preambles
• IRS Publications
• EBIA Committee Report Excerpts
• PLRs and TAMs (1977 - present)
• Revenue Rulings (1954 - present)
• Revenue Procedures (1955 - present)
• Announcements (1959 - present)
• Notices (1980 - present)
• Internal Revenue Manual

• Self-Insured Health Plans
  • I. Overview of This Manual
  • II. [Reserved]
  • III. Overview of Self-Insured Health Plans
  • IV. Why Self-Insure?
  • V. Governing Law and ERISA Preemption
  • VI. Federal Tax Treatment of Self-Insured Health Plans
  • VII. [Reserved]
  • VIII. Plan Sponsor's Roles as Settlor and Fiduciary; Plan Governance
  • IX. Written Plan Document
  • X. Plan Design: Determining How Many Plans to Maintain
  • XI. Designing Benefit Options in a Self-Insured Health Plan
  • XII. Nondiscrimination Rules Under Code §105(h)
  • XIII. Covered Benefits
  • XIV. Eligibility
  • XV. Plan Costs, Cost-Sharing Features, and Participant Contributions
  • XVI. Enrollment
  • XVII. Stop-Loss Insurance
  • XVIII. Funding for Self-Insured Health Plans
  • XIX. VEBAs and Other Trusts
  • XX. Identifying ERISA Plan Assets
  • XXI. ERISA's Trust, Exclusive Benefit, and Bonding Requirements
  • XXII. Mistakes Happen: Self-Insured Health Plan Compliance Mistakes
  • XXIII. Selecting, Engaging, and Monitoring Service Providers
  • XXIV. [Reserved]
  • XXV. Coordination of Benefits, Subrogation, and Escheat
  • XXVI. Claims and Appeals
  • XXVII. COBRA: Continuation Coverage
  • XXVIII. Participant Disclosure Requirements for Self-Insured Health Plans
  • XXIX. Reporting Requirements for Self-Insured Health Plans
  • XXX. Recordkeeping for Self-Insured Health Plans
  • XXXI. HIPAA Privacy, Security, and EDI
  • XXXII. Audits of Self-Insured Health Plans
  • Index
    • Numerics
    • A
    • B
    • C
    • D
    • E
    • F
    • G
    • H
    • I
    • J
    • L
    • M
    • N
    • O
    • P
    • Q
    • R
    • S
    • T
    • U
    • V
    • W
  • Appendix
    • Resources
    • Sample Documents

• EBIA's Self-Insured Health Plans: List of Sample Documents View
• EBIA's Self-Insured Health Plans: What's New View