Automate and Ensure ERISA Compliance

Ensure conformity with ERISA and strengthen your role as a corporate fiduciary—all while protecting members and your bottom line.

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The Problem

Self-insured employers have opted to self-fund their healthcare plans in an effort to reduce extraneous spend, maximize control, and enhance member value. Research indicates that self-funding, once a practice exclusive to large corporations, has now become widely leveraged by mid- and small-sized organizations as well.

Self-insured employers, no matter their size, are all subject to ERISA law. While ERISA’s prudent standard requires employers to understand what is happening with their claims, most still lack critical visibility into claims data that is independent of the TPA. Lack of visibility into an employer’s health care plan can create massive ERISA risk exposure, with significant legal and financial penalties for the plan fiduciaries.

The Solution

It’s more than an employer’s right to know what’s happening with their claims data. It’s their responsibility under ERISA law. 4C Health Solutions masters the right and responsibility of self-insured plan management by enabling employers to:

Achieve Independent Visibility

For the first time, 4C provides self-insured employers complete and independent visibility over claims data across all of their major claim lines.

Actively Vet & Pay Only Legitimate Claims

Using 4C’s active interventional analytics, employers can rapidly vet claims in real time and preempt suspect or fraudulent payments before they are made.

Automate Reporting & Disclosure

4C dynamically generates timely and accurate reports that can be leveraged by self-insured employers for regulatory reporting and employee education.

Proactively Uncover & Address Issues

By continuously monitoring self-insured plans for issues and opportunities for improvement, 4C is the only platform on the market designed to help employers strengthen their fiduciary roles.

fraud by the numbers

By the Numbers

corporate fiduciaries

Corporate fiduciaries can be held personally liable for financial and legal penalties under ERISA, legislation that passed in 1974.

self funded plans

80% of U.S. employees with benefit plans are in self-funded plans.

Self Funding Success

medium sized employers

More than 66% of medium-sized employers use self-funding.

Self Funding Success

small self insured

The percentage of small establishments that offer self-insured plans rose from 14.2 percent in 2015 to 17.4 percent in 2016.

Insurance News Net

“Most employers sponsoring fully or partially self-funded group health plans exercise some discretionary authority and therefore are a fiduciary…The duty to act prudently is one of a fiduciary’s central responsibilities under ERISA.

– “Understanding Your Fiduciary Responsibility Under a Group Health Plan,” Employee Benefits Security Administration, Department of Labor

infographic totaling fraud damages

Infographic

Totaling the Damages
An Employer’s Guide to Quantifying & Eliminating Fraud, Waste & Abuse

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From Our Blog

 

May 7, 2019

Healthcare’s Up-and-Coming Changemakers

Recent News

 

June 25, 2019

4C Supports Senate HELP Committee’s Efforts to Tackle Rising Health Care Costs & Health-Data Access

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