11/07/2025
It is highly recommended that a company of your size use a
a.
Third Party Administrator to handle the complex administrative duties of a self-insured plan, which include:
i. Managing claims-The Third Party Administrator processes and pays claims from a dedicated trust or bank account that you fund.
ii. Ensuring compliance- The Third Party Administrator helps you navigate complex federal regulations, including the Employee Retirement Income Security Act (ERISA), the Affordable Care Act (ACA), and health insurance portability and privacy act (HIPPA).
iii. Providing network access-The Third Party Administrator provides access to a network of healthcare providers and negotiates rates on your behalf.
iv. Handling documentation- The Third Party Administrator assists with all required reporting to the Internal revenue service (IRS), such as filing Forms 1094-B and 1095-B.
2. Even with a solid understanding of administration, a small business has less financial capacity to absorb the risk of large, unpredictable claims. Stop-loss insurance protects your company from catastrophic claims that exceed a pre-determined amount for any single employee.
