Venable attorneys have decades of experience assisting large and small employers across a wide range of industries with their health and welfare benefit needs. Our attorneys work efficiently and effectively to help employers control the cost of health and welfare benefits, ensure that vendor contracts and plan documents provide the most comprehensive protection for the employer, and advise the employer on all applicable legal requirements.
HELPING BUSINESSES CONTROL HEALTH BENEFIT COSTS
Negotiating with Insurance Companies
We design and customize model contracts to meet operational needs while providing a clear definition of the business relationship and the responsibilities of the vendor. Through the model contract, we simplify contract administration, add cost-saving provisions, ensure sufficient legal protections, and facilitate appropriate compliance with performance standards, relevant laws, and regulations.
Developing a Customized RFP Process
Our attorneys develop a customized RFP process, utilizing the custom model contract to assist employers with the selection of healthcare vendors. The customized RFP provides a baseline to compare each vendor’s willingness to agree to provisions of the model contract, and allows employers to identify the vendors that are most willing to agree with their requirements. We also assist employers with the negotiation of contracts with vendors using the model contract and their responses to the RFP.
Negotiating with Pharmacy Benefits Managers
Venable puts employers in control of developing prescription drug formularies, which can save businesses between 10% and 25%. We provide our Therapeutic MAC formulary to maximize utilization of generic drugs that do not rely on a standard Pharmacy Benefit Manager (“PBM”) formularies. We will help employers design limited pharmacy networks that drive down the cost of drugs. Through appropriate PBM selection and contracting, we form a transparent pharmacy benefit that removes any “spread” from the PBM’s profits at your expense and fully accounts for all discounts, rebates and other monies paid by the drug companies to the PBM.
Handling Labor Agreement Negotiations
Our attorneys negotiate collective bargaining agreements for clients in a wide spectrum of industries. In certain situations, we can act as special labor counsel to negotiate only the benefits portion to meet client-specific goals in coordination with the chief negotiator.
RESOLVING ERISA/BENEFITS LAW ISSUES
Preparing Plan Documents
Our team carefully reviews and drafts plan documentation, summary plan descriptions, employee benefit guides, and other communication materials for health and welfare benefit plans of all types. Whether the plans are broad-based or limited to executives only, fully-insured or self-insured, company-subsidized or purely voluntary, funded or unfunded, our goal is to ensure that employees understand the benefits provided and our clients comply with the wide range of federal and state laws and regulations affecting these plans.
Ensuring Compliance with Relevant Laws
We design and implement structured comprehensive compliance programs, with written policies, procedures and training as required by the “alphabet soup" of laws and regulations. These laws include the mandated reforms of the Patient Protection and Affordable Care Act (“PPACA”), the continuing coverage requirements of Consolidated Omnibus Budget Reconciliation Act (“COBRA”), the portability, nondiscrimination, privacy and security requirements of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), the Health Information Technology for Economic and Clinical Health (“HITECH”) Act and other recent laws affecting HIPAA, the coverage requirements of state and local domestic partner health laws, and the requirements for certain minimum benefits under a variety of other laws. These include the Newborns' and Mothers' Health Protection Act ("NMHPA"), Mental Health Parity Act ("MHPA") and Women's Health and Cancer Rights Act ("WHCRA").
Addressing Claims and Appeals Issues, Including Litigation
Our attorneys help businesses coordinate the administration of claims with other sources of reimbursement and coverage to ensure that they achieve their business objectives, avoid costly litigation and optimize savings. As there has been significant growth in disputes over benefit claims and other benefit-related litigation, our team maintains an active, nationwide practice to provide quality, effective, and cost-contained litigation skills and advice.
On a regular basis, we work closely with our clients to develop policies, procedures, and systems for avoiding litigation. However, if an employer or an employee benefit plan is sued or decides to bring suit, we have experienced attorneys available to handle all aspects of the litigation, including case strategy, discovery, motions, depositions and trial.
Reducing Retiree Benefit Costs
Reduction of costs can be achieved through the bargaining process where the employer has reserved the right to modify these benefits. We guide employers through the regulatory maze of Medicare coordination as well as qualifying for and receiving relevant federal subsidies, such as the Retiree Drug Subsidy and the Early Retiree Reinsurance Program.