January 2024

Selecting the right third-party administrator (TPA) partner can significantly impact the success of your self-funded  plan.

Your situation is unique – your health plan solution should be too. Selecting the right third-party administrator (TPA) partner can significantly impact the success of your self-funded plan. If you’re on the fence about switching to a self-insured health plan or considering making a change from your current plan/claims administrator, crafting well-thought-out Request for Proposal (RFP) questions is the cornerstone of the evaluation process.

Of course, costs are important, but you want to go beyond getting a prospective partner’s rates; you want to identify a TPA that aligns with your organization’s goals and ensures the success of your self-funded health plan. Here are a few recommendations on topics and questions to help you identify a fitting partner through the RFP process.

Expertise and Experience

• Question: "Can you provide details about your experience in administering self-funded health plans, particularly those similar in size and structure to ours?"

Technology and Data Management

• Question: "What technological solutions do you offer for claims processing, data analytics, and member communication?"

Network Management and Provider Relationships

• Question: "How do you manage provider networks, and what strategies do you employ to control costs while ensuring quality care for our employees?"

Compliance and Regulatory Expertise

• Question: "How do you stay informed about changes in health care regulations, and how do you assist clients in maintaining compliance with evolving requirements?"

Wellness Program Integration

• Question: "How do you support the integration of wellness programs within self-funded health plans, and what resources do you provide to promote employee well-being?"

Communication and Reporting

• Question: "What communication tools and reporting mechanisms do you provide to keep employers informed about the performance of the health plan?"

Crafting thoughtful and comprehensive RFP questions is the first step in finding the right TPA partner to administer your self-funded employee health benefits. Remember, the right TPA is not just a service provider but a strategic partner in your journey towards a healthier, more engaged workforce. Need help? Check out these tips for more questions you can ask to Recharge Your RFP and why they matter.