FIDUCIARY DUTY LIABILITY PROTECTION
Innovative Program Shifts Fiduciary Burden Away from Employer
Self-funded employers are subject to fiduciary duty under the Department of Labor’s ERISA law. This is a critical responsibility as employers must assure that health claims are paid in a non-discriminatory fashion and that plan assets (the money in the plan) are used appropriately at all times. What if violation of this fiduciary duty occurs? Civil and criminal penalties can be issued.
To protect clients from these costly ramifications, Cypress offers the Plan Appointed Claim Evaluator (PACE) program through its long-time partner, The Phia Group. This innovative, one-of-a-kind solution assumes the fiduciary burden on behalf of self-funded employers and utilizes the firm’s legal expertise when benefit claims are denied and appeals are initiated. It offers critical guidance on complex claims decisions and legal counsel in the event of a lawsuit.
- Thorough review and revision of self-funded plan documents to ensure compliance
- Final internal appeals assessment and issuance of directives as a fiduciary
- Legal analysis of health claim decisions, clinical review and access to URAC-accredited Independent Review Organizations (IROs)
- Confidence that health claims are being processed according to a plan’s specific terms
- Review of stop loss policies and network contracts
- Coordination of administrative appeals and plan representation in the event of any lawsuits
- Financial protection from the lawsuits and/or damages that result from a fiduciary breach or stop loss denial
More on fiduciary duty protection through PACE: