TPA and administrative contracts. Who pays your claims, and on what terms.

If your plan is self-funded, a third-party administrator pays your claims under an administrative services agreement written by the administrator. Ethos Benefits runs the TPA procurement, compares every fee and service term side by side, and redlines the agreement so data access, audit rights and performance standards favor your plan.

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What you get.

The administrative services agreement usually arrives as a document to sign. It decides who can see your claims data, whether you can audit, and what happens when claims are paid wrong.

TPA marketingQualified administrators invited to bid through a standardized RFP, with network, claims and service capabilities scored.
Fee comparisonEvery fee, including network access fees and shared-savings or recovery fees, laid side by side so the true cost is visible.
Agreement redlineThe administrative services agreement and its exhibits marked up as tracked changes, with the reason for each proposed change.
Data and audit rightsYour plan’s right to its claims data and to audit the administrator written into the contract, not left to goodwill.
Performance guaranteesClaims accuracy, turnaround and service standards with money attached when they are missed.
ImplementationEligibility files, carrier and stop-loss coordination, and run-out arrangements set up before the effective date.

What we redline in an ASA.

Claims data: your plan’s right to its own claims data, in a usable format, during the contract and after it ends.
Audit rights: how often your plan can audit, with whose auditor, on what sample, and at whose cost.
Fees: every fee named, including fees taken as a percentage of savings or recoveries.
Fiduciary roles: which decisions the administrator makes, such as claim appeals, and the standard it must follow.
Performance guarantees: measurable standards, how they are reported, and what the plan receives when they are missed.
Termination and run-out: how claims incurred before termination are paid, and for how long.
Privacy: the business associate agreement and how protected health information is handled.

Bundled or unbundled.

Some plans buy network, administration, pharmacy and stop-loss from one company. Others contract each piece separately. Ethos compares both structures for your plan so your committee can see what each one costs and controls.

Part of your Fiduciary Framework™.

Every Ethos service reports to your benefits committee. The work is reviewed at your quarterly committee meeting, each decision is recorded with the reasoning behind it, and the record lives in your Ethos Fiduciary OS. That is what lets your committee show the plan was run prudently.

See the Fiduciary Framework™ · How fiduciary governance works

Questions employers ask about this.

What is the difference between a TPA and ASO?

Both pay claims for a self-funded plan. A TPA is usually an independent administrator, while ASO usually means a carrier providing administrative services only. Either way, the administrative services agreement sets the terms.

Does a fully insured plan need this?

No. On a fully insured plan the carrier administers claims under the insurance contract. TPA procurement applies to self-funded and level-funded plans.

Do we have to change administrators?

No. A redline of your current agreement at renewal is often the fastest way to fix data access, audit rights and fees. Procurement shows whether a change is worth it.

See what your plan is really costing you.

A Strategic Analysis starts with your plan documents and your broker agreement, then shows you what your plan costs, where the risk sits, and what a committee would decide with the full picture.

Request a Strategic Analysis Call (407) 803-4710