The Role of TPAs

Third Party Administrators operate much like independent CPA or law firms…providing continuing professional outside claims and benefit plan administration for client employers and benefit plans. TPAs often become the employee benefits office for the covered workers and employers in the client plan. By tradition, TPAs usually seek a behind-the-scenes role emphasizing the identity of the employer or sponsored plan…rather than blatant advertising of the name of the TPA firm. Thus, the names of even the largest TPA firms are often not widely known to the general public.

 

Most of the TPA client plans employ some degree of self-funding though the hallmark of the phenomenal success of TPAs in recent years has been their willingness to custom-design and implement plans for the specific needs of each employer or group of workers or health provider arrangement. Because efficient TPAs are often able to provide administration at 40% of what insurers and others charge, there has been a boom in recent years of insurance companies, Blue Cross/Blue Shield, HMOs medical providers and others outsourcing their administration to TPAs, for their plans.

 

Clients of TPAs include every size and format of employment…from large Taft-Hartley union/management jointly-administered plans…to custom-made for single employers..to cost-effective plans designed for related groups of employers in trade associations and other multiple employer configurations…to plans for state & local government workers…and employees of religious groups…to hospital & doctor sponsored plans (such as PHO, EPO, etc.)…to MSAs. Through innovation and careful planning, TPAs have led the way in making cost-effective group employee benefit coverage available to even the smallest employers.

 

The TPA industry has also played an active hands-on role in shaping and implementing accurate compliance with the host of new government requirements. Every year, there are over 1,000 new laws, regulations, technical decisions, opinions, court cases, interpretations, and other rulings from about 300 government entities which plans, employers and/or administrators must obey. Only about 1/3 ever get adequate announcement or explanation from the government or even technical trade press…yet still carry the effect of law and must be obeyed. Only about 1% (yes, only one percent) of all requirements ever get formal comprehensive guidance on how to obey. Part of the growth of the TPA market and SPBA membership is the desire of plans and employers to be sure to have professionals well-versed in these government requirements handling their employee benefit plans. SPBA members take great pride in the role they have played in spreading coverage for workers and smoothing the often bumpy road of government legislation and regulation.