TRIBAL SELFINSURED HEALTH PLANS PAYOR OF LAST RESORT
TRIBAL SELF-INSURED HEALTH PLANS PAYOR OF LAST RESORT Presented by: Tyler Moore, Mattecheck & Associates and Face Rock Enterprises
PAYOR OF LAST RESORT - OVERVIEW q Under 25 U. S. C § 1623(b) the Tribe becomes the payer of last resort for claims incurred by a Contract Health Services (CHS) eligible member/employee q All other coverage would be primary including: q Coverage under a spouse’s health plan q Coverage under Medicare q Coverage under Medicaid
PAYOR OF LAST RESORT – FINANCIAL BENEFIT q Positively impacts the CHS and Health Plan budget by shifting claims cost to other payers without impacting the members out-of-pocket (both the Tribal Member Plan and the Employer Sponsored Plan) q Impact varies drastically based on: q Number of CHS eligible employees q Number of Tribal Members who have other coverage
PAYOR OF LAST RESORT – KEY FEATURES q The Tribe’s health programs must be selffunded q The health plan documents must have the correct language included q The Tribe and/or the health plan third party administrator (TPA) must correctly manage eligibility q The Tribe’s TPA must understand how to apply and enforce the Payor of Last Resort
PAYOR OF LAST RESORT - CONSIDERATIONS q Partner with a subject matter expert to help set up and manage the Tribe’s health programs q Find the right third party administrator (TPA) q Conduct a coordination of benefit (COB) audit q Provide Tribal Member assistance – enrolling in Medicare/Medicaid
PAYOR OF LAST RESORT – QUESTIONS? Questions? Tyler Moore tmoore@mattecheck. com (541) 504 -4139
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