BENEFIT PLAN DESIGN AND DEVELOPMENT SERVICES 

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