For employers and plan sponsors
Know what your self-funded plan documents require—and where they leave you exposed.
We review the documents governing your plan, compare them with vendor responsibilities and intended administration, and give your team a practical path for resolving identified gaps.
A plan is only as reliable as the documents behind it.
- The plan document defines what the plan promises.
- The SPD tells participants how the plan works in practice.
- The TPA agreement says who does what — and where the handoffs happen.
- The stop-loss policy shapes how large claims are handled.
- Amendments, vendor arrangements, and notices should all point in the same direction.
- When they do not, the gap usually shows up after a problem has already occurred.
What we review
The documents and provisions that govern your plan.
Nine areas where document language, vendor duties, and day-to-day administration most often diverge.
Plan document and Summary Plan Description
We compare the formal plan document with the SPD to identify inconsistencies participants might rely on.
Amendments and summaries of material modifications
We trace how past changes were documented and whether they are reflected across the plan record.
TPA or administrative services agreement
We review duties, deadlines, data handling, and limitations so responsibilities match what you expect.
Stop-loss policy and relevant provisions
We look at contract terms, exclusions, and conditions that can affect how claims are reimbursed.
Eligibility, exclusions, and benefit provisions
We check that eligibility and benefit terms are stated consistently across documents.
Claims and appeals language
We review procedures, timelines, and notice requirements that apply to participant claims.
Subrogation and reimbursement provisions
We examine language that affects recovery rights and coordination with other coverage.
Vendor responsibility and document conflicts
We identify places where one vendor's obligations overlap or conflict with another's.
Required notices and administrative procedures
We note missing or outdated notices and procedures that should support plan administration.
What you receive
A clear read on where your plan stands.
- A written findings report
- A plain-English summary of what we reviewed and what we found, organized by topic.
- A risk-prioritized issue list
- Issues ranked by practical impact so you can decide what to address first.
- A document-to-document discrepancy summary
- Specific places where one document says something another contradicts or leaves out.
- Recommended next steps
- Practical options for correction, amendment, or follow-up review — without legal advice.
- A review meeting with the employer and broker
- A working session to walk through findings and agree on ownership.
- Optional renewal-cycle or ongoing review
- Re-checking documents as amendments, vendors, or plan terms change over time.
How our review works
From documents to decisions.
- 01
Collect
The client or broker provides the relevant plan documents, agreements, amendments, and supporting materials.
- 02
Compare
We examine how plan terms, vendor responsibilities, and intended administration align.
- 03
Prioritize
We organize findings by significance, explain why they matter, and identify the appropriate responsible party.
- 04
Resolve
We support coordination among the employer, broker, TPA, vendor, stop-loss carrier, or legal counsel as appropriate.
Plan Document Review — Findings Summary
Plan Year redacted · Prepared for redacted
| Document | Provision | Observation | Priority | Recommended Next Step |
|---|---|---|---|---|
| Plan Document | Eligibility definition | Definition differs from the description used in enrollment materials. | High | Confirm intended terms and align documents. |
| SPD | Claims and appeals timeline | Stated timeframes do not match the administrator's published procedure. | High | Reconcile with TPA and update disclosure. |
| TPA Agreement | Allocation of responsibilities | Certain administrative duties are not clearly assigned to either party. | Medium | Clarify responsibility in writing at renewal. |
| Stop-Loss Policy | Covered expense definition | Policy language is narrower than the benefits described in the plan. | Medium | Raise with carrier and broker for review. |
| Amendments | Execution and recordkeeping | One amendment referenced in materials is not present in the file provided. | Low | Locate signed copy for the plan record. |
Our approach
What you can expect from the review
- 01
Findings tied to specific documents and provisions
- 02
Clear separation between observations and legal advice
- 03
Priorities explained in practical business language
- 04
Coordination with the broker and existing service providers
- 05
A written record of identified issues and next steps
Request a Self-Funded Plan Document Review
Tell us what documents you have and what is changing in your plan. We will come back with a scope and a practical path forward.