In a self-funded plan, EPOCH works with the employer to custom design a plan that meets both their financial objectives and their employees’ needs. Since self-funded plans are only subject to federal laws and regulations (e.g. ERISA, HIPAA), and not subject to state regulations, employers may choose to eliminate duplicative, expensive state-mandated benefits, if desired. This also allows the employer to offer uniform benefit plans across state lines.

EPOCH will also help the employer obtain stop-loss arrangements that give the health plan protection from both a specific individual catastrophic claim as well as aggregate claims that exceed a pre-designated threshold. The amount the employer decides to reinsure is dependent on their tolerance for risk. EPOCH is an independent TPA, and therefore, not required to purchase stop-loss insurance from any particular company. However, because of our size, health management programs, and systems, we are a preferred TPA for many top-rated stop-loss carriers. Annually we check the reinsurance market to be sure that our clients are buying the most cost effective coverage available.

EPOCH works with a number of “best in class” business partners that provide our clients a wide range of tools that we use to customize solutions that will help employers achieve their overall objectives. EPOCH will help the employer and their brokers design these aspects of their plan including the integration of provider/pharmacy networks; disease prevention/health management interventions; reporting and web requirements; and other cost containment services. After all provisions of the plan (including exclusions and limitations) are determined, EPOCH will prepare a federally compliant Summary Plan Description (SPD) that can be printed and distributed to covered employees.

Finally, EPOCH will administer the plan. Our professional staff is an experienced and well trained group, who consistently exceeds industry service standards. Our administrative responsibilities include preparing the plan document and SPDs and ID cards; maintaining eligibility; claims adjudication and payment; customer service; vendor management and product integration; systems/web maintenance, connectivity, and security; and client specific management reporting.