Some actions fiduciaries need to consider when selecting a service provider include:
• Getting information from more than one provider
• Comparing providers based on same information (for example, services offered, experience and costs)
• Obtaining information about the provider itself, including financial condition and experience with group health plans of similar size and complexity
• Evaluating information about the quality of the firm’s services, including the following (as applicable):
◦ The identity, experience and qualifications of professionals who will be handling the plan or providing medical services
◦ Any recent litigation or enforcement action that has been taken against the provider and the provider’s experience or performance record
◦ Ease of access to medical providers and information about the operations of the health care provider
◦ The procedures for timely consideration and resolution of patient questions and complaints
◦ The procedures for the confidentiality of patient records
◦ Enrollee satisfaction statistics
• Ensuring that any required licenses, ratings or accreditations are up to date (for example, insurers, brokers, TPAs, health care service providers)
An employer should document its selection (and monitoring) process, and, when using an internal administrative committee, should educate committee members on their roles and responsibilities.
ERISA includes standards of conduct for those who manage an employee benefit plan and its assets, who are called “fiduciaries.” This Legislative Brief includes a set of frequently asked questions (FAQs) to help employers understand the basic fiduciary responsibilities applicable to group health plans under ERISA.