Importance

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Abstract

A self-insured or self funded medical benefit plan is provided by an employer wherein the self-insured medical benefit plan is governed by ERISA, and wherein the employer who is providing the medical benefit plan is 100 percent responsible for payment for medical services provided to an employee, receiving the benefit of the medical benefit plan, to a medical service provider for covered medical services and products. The medical benefit plan and method for providing the medical benefit plan determines a reasonable value for the medical services provided by a medical service provider to a participant of the plan, reprices a bill or claim from the medical service provider, and protects the participant/employee under ERISA from attempted collections of additional moneys that a medical service provider may believe is owed for the medical services but were not paid by the exemplary self insured medical benefit plan.

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First Claim