1. An Overview of Group Insurance - Group Health Insurance
- The Uninsured
- Group Insurance
- Types of Insurance Professionals
- Intermediaries
- Blue Cross/Blue Shield Plans
2. State and Federal Laws - Legal Factors Affecting Design
- State Law
- Federal Law
- Pregnancy Discrimination Act
- Family and Medical Leave Act
- Americans with Disabilities Act
- Taxation of Group Health Plans
- Reservists' Benefits
3. Eligibility 4. Types of Medical Plans - Traditional Plans
- Managed Care
- Health Maintenance Organizations
- Adverse Selection
- Legal Standards
- Evaluating HMOs
- Preferred Provider Organizations
- POS
- Managed Care Backlash
5. Factors Influencing Plan Design - Strategies
- Contributions
- Types of Plans
- Covered Expenses
- Restrictions on Coverage
- Deductibles, Copayments, and Reimbursement
- Cost Containment
- Managed Competition
6. Flexible Benefits - Tax Advantages
- Cost Control
- Types of Plans
- Flexible Spending Accounts
- Mid-Year Plan Changes
- Flexible Benefit Options
- Implementation
7. Consumer-Driven Health Plans - Health Savings Accounts
- Health Reimbursement Accounts
- Medical Savings Accounts
- Consumer-Driven Dental Care
- Defined Contribution Health Care
8. Plan Implementation and Administration - Setting Up the Plan
- Reporting and Disclosure
- Enrollment
- Billing
- Claims
- Coordination of Benefits
- Coverage, Renewal, and Changes
- Termination of Coverage
- Computerized Administration
- Billing Codes
- Third-Party Administrators
9. Health Insurance Portability and Accountability Act (HIPAA) - Portability
- Electronic Data Interchange
- Privacy
- Security
10. COBRA - The Basics
- Covered Employers
- Covered Plans
- General Requirements
- Notification Requirements
- Premiums
- Election and Grace Periods
- Qualified Beneficiaries
- Retiree Medical Coverage
- Miscellaneous
11. Form 5500 - Plan Years
- Administration
- Completing the Form
- Electronic Filing
- Summary Annual Report
12. Nondiscrimination Rules - Accident and Health Plans
- Cafeteria Plans
- Voluntary Employees' Beneficiary Associations
- Nondiscriminatory Classification
- Nondiscrimination Rules for Archer MSAs
- Comparability Rules for health savings accounts (HSAs)
- Controlled Group Rules
- Tax-Exempt Organizations
- Comparisons
13. Plan Rating and Funding - Plan Funding
- Fully Insured Plans
- Alternatives to Fully Insured Plans
- Deferred Premium Arrangements
- Shared Funding Arrangements
- Retrospective Premium Arrangements
- Reserve Reduction Agreements
- Minimum Premium Plans
- Captives
14. Self-Funding - Reasons for Self-Funding
- Decision to Self-Fund
- Administration
- Marketplace
- Effect of Self-Funding on Regulations
- Stop-Loss Insurance
- Voluntary Employees' Beneficiary Associations
15. Vendor Selection - Types of Vendors
- Selection Process
- Role of the Intermediary
- Choosing Intermediaries
- Choosing Other Specific Types of Vendors
16. Managing Health Insurance Costs - Factors Affecting Costs
- Health Care Data
- Utilization Review and Case Management
- Additional Cost-Management Strategies
- Rationing Health Care
- The Employer's Role
17. Wellness Plans - Health Promotion and Wellness
- Health and Productivity Management
18. Pharmacy Benefit Management - The Basics
- Pharmacy Benefit Design
- Cost Control
- Coverage Disclosure Considerations
- Cost Considerations
- The Global Drug Market
- Pharmacy Benefit Managers
- Choosing a Pharmacy Benefit Manager
- Ensuring Quality
- Cost Management Concepts
- Utilization Management Concepts
- Formularies
- Prior Authorization Programs
- Disease State Management
- Quality Management/Oversight
- Pharmacy Issues in Workers' Compensation Insurance
19. Retiree Health Benefits - Regulatory Issues
- Eligibility and Plan Design
- Determining and Allocating Costs
- Retiree Medical Liabilities
- Pre-Funding
- Medicare Solutions to Retiree Challenges
20. Medicare - The Basics
- Medicare Order of Benefit Determination
- Medicare Cost Containment
- Medigap
- Medicare Advantage
21. Medicare Part D Benefit - Enrollment
- Employer Incentives to Participate
- Standard Benefit
- Pharmacy Network Contracting
- Formularies and Part D
- Medication Therapy Management (MTM)
- Skilled Nursing Facility (SNF)/Nursing Facility (NF) Impact
- Quality Measures
- Audit Issues
- Coordination of Benefit (COB) Issues
22. Quality Assurance - Quality Measures
- Report Card Movement
- The Joint Commission and HEDIS
- Outcomes Measurement
23. Mental Health - Mental Health Benefits
- Controlling Costs
- Substance Abuse
- Managed Mental Health
- Employee Assistance Programs
- Outcome Measurements
- Americans with Disabilities Act
- Mental Health Parity Act
24. Dental, Vision, and Other Benefits - Dental Benefits
- Vision Benefits
- Hearing Benefits
- Long-Term Care
25. Communication - Developing Communication Strategies
- Benefit Statements
- Periodic Benefit Reports
- Interactive and Online Systems
- Open Enrollments
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