Reading 32BJ's Healthcare Administrative Report

“The more I practice, the luckier I get.” - Arnold Palmer.

What did you do to practice this week?

One of the things I did was read SERVICE EMPLOYEES 32BJ NORTH HEALTH FUND’s “Healthcare Administrator Contract-first Template.”

I’d strongly recommend benefits advisors do the same.

No, your clients probably aren’t going to get vendors to accommodate the same demands 32BJ gets with their 200,000 members, but it’s a good place to start if you’re looking for fresh ideas to bring to clients who may be asking what “prudent experts” are doing these days.

Some (not all) of what I liked:

2.03(a) - no upside down claims. If the billed amount is less than the negotiated rate, pay the billed amount.

2.06(c) - site neutral payments. No facility fees.

2.06(d) - plan sponsor is in control of subrogation.

2.14 - TPA is responsible to collect overpayments at TPAs cost. No reward for messing up the first time.

6.03 - all rebates belong to the purchaser.

7.02 - all deliverables are property of the purchaser.

7.10 - purchaser gets full access to claims data as defined by Exhibit B. Really good stuff here.

This kind of stuff is the practice that leads to more “luck.”

Also, give a follow to Stacey Richter and her Relentless Health Value Podcast. She interviewed Claire Brockbank about the 32BJ approach and it’s a great interview.