Plan Language & Program Consultancy

Self-funding is a popular option for many companies, particularly large employers as it allows them to pay for some or all of their workers’ health services directly from their own funds instead of purchasing health insurance for them. Self-funded plans established by private employers are exempt from most state insurance laws, reserve requirements, mandated benefits, premium taxes, and many consumer protection regulations, thanks to federal law (the Employee Retirement Income Security Act of 1974, or ERISA).

Ensuring full reimbursement to your self-funded health plan can be a complex and daunting process. To achieve maximum reimbursement, specific plan language is required under ERISA. With legal rulings frequently varying, plan language must be updated to remain current. At Vengroff Williams, our in-house attorneys specialize in plan language design and consultancy, ensuring that our clients’ plans incorporate the strongest language to retain their medical subrogation and reimbursement rights.

The dynamic legal team Vengroff Williams works to eliminate any “contractual gap” in the plan language to bolster the plan’s rights. We understand that many corporations use multiple administrators and often encounter challenges in coordinating medical subrogation efforts across them. Leveraging our legal teams’ expertise in plan design and medical subrogation enables us to create plans that cover multiple administrators and coordination of benefits provisions while ensuring that the medical subrogation and reimbursement provisions remain consistent and enforceable.

As each corporation has its own unique requirements, our team of legal experts can navigate through collective bargaining agreements, distinct operating companies, major geographic differences, and other individual considerations. Our mission is to empower our clients with the necessary tools to customize their medical subrogation programs and maximize their reimbursement opportunities.