We review and update benefit plan language for ERISA plans including but not limited to the following areas:


  •   Clear exclusion language
  •   Experimental/Investigational definition based on both commercial as well as Medicare standards
  •   In vs. out of network benefit structural elements
  •   Preventive service levels detailed and defined
  •   Cosmetic vs. reconstructive vs. medically necessary elements
  •   Continuation of coverage and extension of benefits
  •   Benefit overrides and one time plan exceptions
  •   Custodial vs. skilled care definition
  •   Drug review: formulary, off-label and FDA-approved
  •   Behavioral health: substance abuse and mental health
  •   Emergency vs. urgent vs. non-urgent care
  •   Hospice, home health benefit structure
  •   Therapies: physical, occupational, speech and chiropractic
  •   Coordination of benefits