What plan means the organization assumes responsibility for claims management and claims data management using internal staff?

What plan means the organization assumes responsibility for claims management and claims data management using internal staff?

• A. Self-insured Plan
• B. Recovery
• C. Self-administered Plan
• D. Non-waiver agreement

Answer: (C)

When an organization handles claims processing and maintains claims data with its own staff, the plan is self-administered. This means the employer administers the benefits in-house, taking on tasks like adjudicating claims, managing eligibility, and generating responsibility for data and reporting without relying on an external administrator. It’s about who runs the day-to-day administration, not merely who funds the claims. This differs from a plan where the organization finances the claims itself (self-insured) but may still outsource claims processing to a third-party administrator; in that case, administration isn’t fully in-house. The other options don’t fit because they refer to different concepts: one is about funding risk, and the other about legal waivers, not internal administration of claims and data.

When an organization handles claims processing and maintains claims data with its own staff, the plan is self-administered. This means the employer administers the benefits in-house, taking on tasks like adjudicating claims, managing eligibility, and generating responsibility for data and reporting without relying on an external administrator. It’s about who runs the day-to-day administration, not merely who funds the claims.

This differs from a plan where the organization finances the claims itself (self-insured) but may still outsource claims processing to a third-party administrator; in that case, administration isn’t fully in-house. The other options don’t fit because they refer to different concepts: one is about funding risk, and the other about legal waivers, not internal administration of claims and data.