Improve access to parity data for ERISA plans
Recommendation
Congress should amend federal health coverage statutes such as the Employee Retirement Income Security Act (ERISA) to prohibit third-party administrators (TPAs) from refusing to provide their employer clients with critical coverage information and data necessary for compliance with key federal coverage laws, including the Mental Health Parity and Addiction Equity Act (MHPAEA).
Background/summary
Self-funded employer plans (typically large employers) frequently hire third-party administrators (TPAs) to administer health plan benefits on their behalf. These TPAs are usually well-known insurance companies with recognizable brand names. Employers seeking to comply with the Mental Health Parity and Addiction Equity Act (MHPAEA) and other health coverage rules have reported that some TPAs refuse to provide information and data on the employers’ health plans, claiming that the information is proprietary. “[Employers] also say they often are unable to get the information they need from third parties—typically insurers—that administer their plans.”[1] Such refusals are unacceptable and inconsistent with employers’ and TPA’s obligations under the law. TPAs should be prohibited from imposing such indefensible barriers to compliance.
citations
1. Bloomberg Law. Employers Await Mental Health Parity Help as Frustrations Build. Last Accessed June 5, 2023.