# Varipro - Full Documentation Digest
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title: "News & Events"
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News & Events
Stay informed with the latest news, compliance updates, and events from Varipro. Browse our articles covering ACA bulletins, ERISA guidance, healthcare cost management, and industry insights.
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Home
Smart About Benefits™
Varipro is an independent, full-service boutique Third Party Administrator committed to serving our clients with passion and purpose. We provide innovative solutions to deliver high-quality, high-value healthcare products and services to the communities we support.
[Learn about our Products & Services](https://varipro.com/products-services/)
Why Varipro?
Varipro stands apart from other TPAs by offering truly client-focused solutions. As an independent TPA not owned by a network, we provide customized benefit plans designed with cost control and flexibility in mind, ensuring our clients receive tailored solutions that meet their unique needs.
We have the flexibility to work with any network or vendor and strive to partner with those who share our commitment to our clients’ success. Our goal is to create strategic collaborations that deliver the best possible outcomes for the organizations we serve.
[Know more!](https://varipro.com/wp-content/uploads/2025/09/SmartSheet_Why_Varipro.pdf)
Cost Savings
Take control of your healthcare spending and achieve your financial goals. Our personalized reports provide clear insights into where each benefit dollar is going. By analyzing this data together, we make strategic plan adjustments to maximize savings and efficiency.
Flexible Plan Design
Design a benefits plan that puts you in control. Choose the coverage that best fits your organization’s needs, whether it’s a simple plan or a highly complex structure. Our experienced team has the expertise to handle it all, ensuring a seamless and tailored solution for your business.
Personalized Support
Enjoy the convenience of a dedicated, responsive representative managing your account. Whether you have a question or concern, you’ll always know exactly who to call, email, or meet with for prompt and reliable support.
Transparent Reporting
Stay informed with clear, detailed insights into your plan, costs, claim activity, and more. Our personalized reports empower you to make confident, data-driven decisions for your organization.
How Varipro helps
Varipro and Third Party Administration
Varipro is a trusted third-party administrator (TPA) specializing in tailored healthcare benefit solutions for both employees and retirees. When you opt for a self-funded benefits program, our team of insurance and administration experts is here to support you every step of the way. Serving nearly 200 employers nationwide, we manage benefits for over 20,000 active and retired employees. Get in touch with us today—we’d love the opportunity to help you be Smart About Benefits!
[Contact us today](https://varipro.com/contact-us/)
About Varipro
Varipro and Third Party Administration
Varipro has been a Taft-Hartley-owned company since 2012, delivering personalized solutions that go beyond expectations. Originally founded in 1992 as Professional Benefits Services (PBS), we rebranded as Varipro in 2016 to reflect our adaptability and diverse expertise. Our fully customizable solutions are tailored to meet each client’s unique needs.
Headquartered in Grand Rapids, Michigan, with an office in Livonia, we are committed to sharing our expertise in benefit administration with agents and employers. Through long-term partnerships, we empower our clients with the knowledge and resources needed to manage their benefits effectively.
[Contact us today](https://varipro.com/contact-us/)
Get Solutions Fast
Partnering with Brokers for Effective Healthcare Solutions
We partner with brokers to deliver innovative, cost-effective healthcare solutions tailored to their clients’ needs. Our goal is to help employers manage rising healthcare costs while ensuring employees have access to high-quality care. Together, we focus on building sustainable strategies that drive long-term value and measurable results.
Client Success
80
%
Businesses Advised
220
+
Guides Given
500
+
Awards Achieved
25
+
---
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title: "Thank You"
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Thank You
Thank You for Reaching Out to Varipro!
We’ve Received Your Information
Thank you for contacting Varipro. Your inquiry is important to us, and a member of our team will review your message and get back to you shortly. As a dedicated Third Party Administrator (TPA), we are committed to providing personalized, client-focused solutions that meet your unique healthcare benefit needs.
What to Expect Next
One of our experienced representatives will reach out to you within the next 1-2 business days. In the meantime, we invite you to explore more about how we help organizations be Smart About Benefits™.
Discover More About Varipro
While you wait, feel free to learn more about our comprehensive solutions and how we can support your organization:
•Products & Services: Discover our tailored benefit plans designed for cost control and flexibility.
•For Employers: See how we help you manage healthcare spending and achieve your financial goals with transparent reporting.
•For Agents: Learn about our partnerships with brokers to deliver innovative, cost-effective healthcare solutions.
Need Immediate Assistance?
If your inquiry is urgent, please don’t hesitate to call us directly during our business hours (Mon 8 AM – 6 PM ET, Tues-Fri 8 AM – 5 PM ET):
•Toll-Free: 1-800-732-3412
•Grand Rapids Office: 616-285-2480
We look forward to speaking with you and exploring how we can partner to deliver the best possible outcomes for your organization.
The Varipro Team
Smart About Benefits™
---
---
title: "Campro"
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---
Campro
CAMPRO is a health solution designed for the Construction Association of Michigan (CAM), which provides six level-funded medical plans and three prescription drug plans, combining the stability of fully insured coverage with the cost advantages of self-funding.
[LEARN MORE](https://www.buildwithcam.com/campro-health-insurance)
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---
title: "Secure Online Payment"
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Secure Online Payment
Make a Secure Online Payment
Our secure online payment portal is available for your convenience. Use it to:
1. Submit Premium Payment
2. Make a one-time remittance for overpayments
Click the link below to access the portal and complete your transaction safely.
A 3% surcharge applies to all credit card transactions. This fee is waived when using a debit card.
[Secure Online Payment Portal](https://pay.sfpgateway.com/VariproMemberPayment)
---
---
title: "COBRA"
url: "https://varipro.com/cobra-2/"
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---
COBRA
COBRA Benefits
Login to COBRA Portal
Use our COBRA Portal to review information about your COBRA benefits and make online payments.
[Go to the COBRA portal](https://cobra.varipro.com/)
---
---
title: "Flexible Spending Account (FSA), Health Reimbursement Account (HRA), Dependent Care Reimbursement (DCAP) & Commuter Benefits"
url: "https://varipro.com/flexible-spending-account-fsa/"
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last_updated: "2026-07-28T15:54:30-04:00"
---
Flexible Spending Account (FSA), Health Reimbursement Account (HRA), Dependent Care Reimbursement (DCAP) & Commuter Benefits
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title: "Medical, Dental and Vision Members"
url: "https://varipro.com/medical-dental-and-vision-members/"
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---
Medical, Dental and Vision Members
---
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title: "Flexible Spending Account"
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---
Flexible Spending Account
---
---
title: "Sitemap"
url: "https://varipro.com/sitemap/"
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Sitemap
Sitemap
Pages
- [About TPAs](https://varipro.com/about-tpas/)
- [Agents](https://varipro.com/agents/)
- [Campro](https://varipro.com/campro/)
- [COBRA](https://varipro.com/cobra-2/)
- [COBRA](https://varipro.com/cobra/)
- [Contact Us](https://varipro.com/contact-us/)
- [Employers](https://varipro.com/employers/)
- [Flexible Spending Account](https://varipro.com/flexible-spending-account/)
- [Flexible Spending Account (FSA), Health Reimbursement Account (HRA), Dependent Care Reimbursement (DCAP) & Commuter Benefits](https://varipro.com/flexible-spending-account-fsa/)
- [HIPAA](https://varipro.com/hipaa/)
- [Home](https://varipro.com/)
- [Medical, Dental and Vision Members](https://varipro.com/medical-dental-and-vision-members/)
- [Members](https://varipro.com/members/)
- [News & Events](https://varipro.com/news-events/)
- [Privacy & Legal](https://varipro.com/privacy-legal/)
- [Products & Services](https://varipro.com/products-services/)
- [Provider](https://varipro.com/provider/)
- [Provider Links](https://varipro.com/provider-links/)
- [Resources](https://varipro.com/educational-resources/)
- [Retirees](https://varipro.com/retirees/)
- [Secure Online Payment](https://varipro.com/secure-online-payment/)
- [Self-Insured Healthcare Made Simple](https://varipro.com/self-insured-healthcare-made-simple/)
- [Sitemap](https://varipro.com/sitemap/)
- [Thank You](https://varipro.com/thank-you/)
- [What Are High Deductible Health Plans?](https://varipro.com/what-are-high-deductible-health-plans/)
- [What are Medical Expense Accounts: FSAs, HSAs, MSAs, and HRAs?](https://varipro.com/what-are-medical-expense-accounts-fsas-hsas-msas-and-hras/)
- [What are Self-Funded Health Plans?](https://varipro.com/what-are-self-funded-health-plans/)
- [What Is A Pharmacy Benefits Manager?](https://varipro.com/what-is-a-pharmacy-benefits-manager/)
- [What is a TPA?](https://varipro.com/what-is-a-tpa/)
- [What Is Claims Transparency?](https://varipro.com/what-is-claims-transparency/)
- [What Is Employee Wellness?](https://varipro.com/what-is-employee-wellness/)
- [What is Level Funding?](https://varipro.com/what-is-level-funding/)
- [What Is Reference-Based Pricing?](https://varipro.com/what-is-reference-based-pricing/)
- [What is Stop Loss Insurance?](https://varipro.com/what-is-stop-loss-insurance/)
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title: "COBRA"
url: "https://varipro.com/cobra/"
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COBRA
COBRA Compliance Toolkit
[](https://varipro.com/wp-content/uploads/2024/09/Varipro-COBRA-Compliance-Toolkit-2024.pdf)
Adobe Acrobat Reader is required to use toolkit. Click [here](https://get.adobe.com/reader/) to download Adobe Reader.
---
---
title: "Self-Insured Healthcare Made Simple"
url: "https://varipro.com/self-insured-healthcare-made-simple/"
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---
Self-Insured Healthcare Made Simple
Self-Insured Healthcare Made Simple
Don’t let the number or scope of options available within self-insured healthcare plans throw you. Think of them as puzzle pieces that work together to create a custom healthcare solution that meets the vision of your company.
Understanding the features and legal requirements of the various options available is a critical step in putting the benefits puzzle together for your company. As a result many organizations feel overwhelmed and intimidated by the idea and number of options offered through self-insured healthcare plans.
Because we believe in helping people be Smart About Benefits™, Varipro introduced SmartSheets. SmartSheets provide simple explanations to the complex puzzle pieces of self-insured healthcare.
SmartSheets Available
- [What are Self-Funded Health Plans?](https://varipro.com/self-funded-health-plans)
- [What is a TPA?](https://varipro.com/what-is-a-tpa/)
- [What is Stop-Loss Insurance?](https://varipro.com/what-is-stop-loss)
- [What is Level Funding?](https://varipro.com/what-is-level-funding)
- [What is Reference Based Pricing?](https://varipro.com/what-is-reference-based-pricing/)
- [What is Claims Transparency?](https://varipro.com/what-is-claims-transparency/)
- [What is Employee Wellness?](https://varipro.com/what-is-employee-wellness/)
- [What is a Pharmacy Benefits Manager?](https://varipro.com/what-is-a-pharmacy-benefits-manager/)
- [What are High-Deductible Health Plans?](https://varipro.com/what-are-high-deductible-health-plans/)
- [What are Medical Expense Accounts?](https://varipro.com/what-are-medical-expense-accounts/)
Every company considering a self-insured healthcare solution is unique, and as such will have unique questions to ask. Varipro and your trusted insurance agent are always available to review your specific needs, help you be Smart About Benefits, and provide detailed information so you can make informed decisions. Be sure to check out all our SmartSheets on the Varipro website.
Frequently Asked Questions
**Q: Is it accurate to assume that if I want the lowest monthly premiums possible I should just select a HDHP?**
A: Lower monthly premiums are just one aspect a HDHP has to offer. Employers considering a HDHP policy should not base their decision solely on that aspect.
Final decisions should be made only after assessing what’s best for your workforce, your budget and your member’s tolerance for a higher level deductible.
**Q: What are some indicators that would confirm HDHP is the right choice?**
A: Some indicators would be:
- A healthy workforce.
- A worklplace culture that promotes wellness.
- Age of those requiring coverage. (individuals 65 years or older and small children tend to require more frequent health care attention.)
- Financial ability of your employees and retirees to tolerate a high deductible plan.
Want to Learn More?
Additional SmartSheet topics are available on the [Educational Resources](https://varipro.com/educational-resources/) page.
[](https://varipro.com/wp-content/uploads/2024/09/SmartSheet_Self-Insured-Healthcare-Made-Simple.pdf)
---
---
title: "What Are High Deductible Health Plans?"
url: "https://varipro.com/what-are-high-deductible-health-plans/"
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---
What Are High Deductible Health Plans?
What are High Deductible Health Plans?
Don’t let the long title or acronym HDHP scare you. Be advised though – health plans within this category require informed decision making. It really comes down to knowing your employees health needs and their money management skills to determine if high-deductible health plans might work.
If you own a car and pay for auto insurance then the term deductible is probably a familiar one. A deductible represents the out-of-pocket dollar amount required in payment by an end user prior to an insurance carrier applying any coverage pertaining to a claim. The higher the deductible on the policy, the lower the monthly premium paid for the coverage. Typically, the same can hold true in health plans.
Here’s the three most important things to understand when considering HDHPs:
Lower Monthly Premiums
HDHP monthly premiums tend to be less – however, it’s critical to note that the low premiums are possible due to the higher deductible levels. The IRS qualifies HDHPs using the following deductible guidelines:
Health Savings Accounts
In order to better prepare for and cover the expense of higher deductibles – HDHP plans allow for a variety of funding strategies.
- Health Savings Account (HSA)
- Health Reimbursement Account (HRA)
- Flexible Spending Account (FSA)
Be Realistic
In considering a HDHP, it’s necessary to realistically assess:
- The health status of your plan participants
- The value/culture of good health & healthy behavior within your organization and
- The financial capability of plan participants to adequately save for and contribute to the cost of high deductibles.
A [TPA](https://varipro.com/what-is-a-tpa/) can help explain the details of HDHPs to enable addressing these considerations and selecting a health plan strategy that works best for your organization.
Frequently Asked Questions
**Q: Is it accurate to assume that if I want the lowest monthly premiums possible I should just select a HDHP?**
A: Lower monthly premiums are just one aspect a HDHP has to offer. Employers considering a HDHP policy should not base their decision solely on that aspect.
Final decisions should be made only after assessing what’s best for your workforce, your budget and your member’s tolerance for a higher level deductible.
**Q: What are some indicators that would confirm HDHP is the right choice?**
A: Some indicators would be:
- A healthy workforce.
- A worklplace culture that promotes wellness.
- Age of those requiring coverage. (individuals 65 years or older and small children tend to require more frequent health care attention.)
- Financial ability of your employees and retirees to tolerate a high deductible plan.
Want to Learn More?
Additional SmartSheet topics are available on the [Educational Resources](https://varipro.com/educational-resources/) page.
[](https://varipro.com/wp-content/uploads/2024/09/SmartSheet_What-are-High-Deductible-Health-Plans.pdf)
---
---
title: "What are Medical Expense Accounts: FSAs, HSAs, MSAs, and HRAs?"
url: "https://varipro.com/what-are-medical-expense-accounts-fsas-hsas-msas-and-hras/"
markdown_url: "https://varipro.com/what-are-medical-expense-accounts-fsas-hsas-msas-and-hras.md"
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last_updated: "2026-07-28T15:54:17-04:00"
---
What are Medical Expense Accounts: FSAs, HSAs, MSAs, and HRAs?
What are Medical Expense Accounts: FSAs, HSAs, MSAs, and HRAs?
*No, it’s not an alphabet game! With a variety of health plan types to choose from, affordability questions extend beyond premiums. Individuals also need to consider how to pay the deductibles and other out-of-pocket expenses of their plan. Several funding strategies exist that allow individuals to set aside needed funds to do just that!*
Let’s take a look at the major funding strategies designed for today’s health plans, which cover out-of-pocket expenses for individuals/families. Each strategy is unique – and collectively are complex, with various rules and regulations in setting them up, facilitating them and adhering to them.
**Health Savings Accounts (HSAs): **a tax-exempt account set up with a qualified HSA trustee to pay or reimburse certain medical expenses you incur, including deductibles of a [HDHP plan](https://varipro.com/what-are-high-deductible-health-plans/).
**Medical Savings Accounts (MSAs):** referred to as Archer MSAs, created to help self-employed and employees of certain small employers meet medical care costs not covered by their HDHP plan.
**Flexible Spending Arrangements (FSAs):** allows employees to be reimbursed for medical expenses. Typically funded through voluntary salary reduction agreements with the employer. Health FSAs are employer-established benefit plans and any contributions into a FSA are tax free.
**Health Reimbursement Arrangements (HRAs):** funded solely by the employer, not through voluntary salary reduction. Employees are reimbursed tax free for qualified medical expenses up to a maximum amount. It may be available along with other health plans including FSAs.
Please be advised, IRS regulations and governmental oversight subject these plans to frequent changes. Stay updated and current with the latest information pertaining to these strategies by accessing Publication 969, available online at [irs.gov](https://www.irs.gov/uac/about-publication-969).
| Funding Strategy Attributes: | HSA | MSA | FSA | HRA |
| --- | --- | --- | --- | --- |
| Provide funds to cover out-of-pocket medical expenses. |  |  |  |  |
| Can only be set up in conjunction with HDHP plans. |  |  | | |
| Must be set up with an approved trustee. |  |  | | |
| Sets limits on the amount contributed per year. |  |  |  | |
| Employee contributions are tax-exempt. |  |  | | |
| Account moves with the employee – even if there is a change of employer. |  |  | | |
| Distributions made as reimbursement or prior to paying bill. |  |  | | |
| Available only to self-employed or employee of small employer (< 50 employees). | |  | | |
| End of year balance of account can be carried over to the next year. |  |  | | |
| Set up as employer-established benefit plan – funded by employee with funds voluntarily withheld from pay. Employer may also contribute. | | |  | |
| Funded solely by the employer with contributions being tax-exempt. | | | |  |
| End of year unused balance is forfeited. | | |  | |
| Distributions from account are for reimbursement only. | | |  |  |
Frequently Asked Questions
**Q: What is meant by a qualified ‘trustee’?**
A: A qualified trustee is recognized as an organization trained, licensed and qualified to manage these types of funding strategies. I.e. banks, insurance companies, TPAs, etc.
**Q: How can I determine which option is the right choice for my organization?**
A: Third Party Administrators, in partnership with your trusted benefits agent, are excellent resources and can provide detailed advice and guidance in selecting the right choice for your organization’s specific needs.
Want to Learn More?
Additional SmartSheet topics are available on the [Educational Resources](https://varipro.com/educational-resources/) page.
[](https://varipro.com/wp-content/uploads/2024/09/SmartSheet_What-Are-Medical-Expense-Accounts.pdf)
---
---
title: "What are Self-Funded Health Plans?"
url: "https://varipro.com/what-are-self-funded-health-plans/"
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---
What are Self-Funded Health Plans?
What are Self-Funded Health Plans?
Compensation packages offering ‘health benefits’ are coming with escalating price tags. A growing number of companies have discovered self-funded health plans add value in cost savings and more.
In basic terms, self-funded health benefit plans (also referred to as self-insured and self-funding) are a health plan strategy where an employer pays member health claims directly to health providers, rather than paying premiums to a health insurance company to cover those claims.
Companies choosing to use self-funded plans bypass the traditional health insurance model and instead work with a Third Party Administrator ([TPA](https://varipro.com/what-is-a-tpa)) in establishing, administering and managing the plan.
How does a self-funded health plan work?
It’s not a complicated process. Companies considering self-funded health plans typically hire a TPA to provide the expertise in developing and administrating a customized plan. Working with a TPA, an employer is able to provide benefits, paying health providers directly only as needed and fixed administrative costs monthly to their TPA. This model represents significant cost savings to a company’s bottom line.
A traditional health insurance plan is built within a business model established by health insurance companies and involves an employer paying monthly premiums covering the projected claims, administrative costs and more to their insurance provider. The insurance company pays plan providers and keeps any unspent dollars as profit.
Why should I self-fund my healthcare plan?
Self-funding represents a variety of benefits to consider –
- Self-funded plans represent a competitive option offering substantial savings for employers.
- Plans can be customized to meet specific company needs.
- Self-funding is regulated on a federal level and often is exempt from state mandates.
- Self-funded administration regulates plan reporting that provide insights and influences strategic decisions of employers.
- Self-funded plans offer a greater sense of financial control for employers.
- As regulations overseeing fully insured health plan requirements evolve, the advantage of customization attributes of self-funded health benefit plans increases.
Self-Funded vs. Fully Insured
Self-Funded Health Benefit Plans
- Improve cash flow by eliminating pre-paying (insurance premiums) for healthcare coverage.
- Customize your benefits to meet specific organization goals and avoid paying for unnecessary healthcare coverage.
- Monthly audits of claims provided, enabling organizations to make adjustments to coverage throughout the year.
- Access to customized monthly claim reports providing plan insight and influencing strategic decisions and control for employers.
- Federally regulated healthcare plan options ensure consistency in benefit administration across geographical locations.
Fully Insured Health Benefit Plans
- Select from a variety of ‘one-size-fits-all’ plans through healthcare insurance provider regardless of past claim history.
- Pre-pay healthcare claim expenses with consistent monthly payments regardless of the number of employee claims.
- Minimal access to detailed reporting specific to an organization’s healthcare costs and claims history.
- Premium rates are fixed annually and change only when the number of employees enrolled changes.
- Regulated by each state which may lead to conflicting benefit mandates and laws as well as potential health insurance premium taxes
Frequently Asked Questions
**Q: How much risk is involved with self-funding?**
A: No one can predict the future when it comes to health and that uncertainty is the risk. Most TPA’s setup what is known as a [Stop-Loss insurance](https://varipro.com/what-is-stop-loss-insurance/) policy that protects the employer from unexpected or catastrophic costs.
**Q: How beneficial are claim reports provided by a TPA?**
A: Federal regulations require TPA’s to track and provide reports to clients. These company-specific reports are updated regularly and contain actionable information that can identify cost savings, guide plan customization and wellness strategy of an employer.
Want to Learn More?
Additional SmartSheet topics are available on the [Educational Resources](https://varipro.com/educational-resources/) page.
[](https://varipro.com/wp-content/uploads/2024/09/SmartSheet_What-are-self-funded-health-plans.pdf)
---
---
title: "What Is A Pharmacy Benefits Manager?"
url: "https://varipro.com/what-is-a-pharmacy-benefits-manager/"
markdown_url: "https://varipro.com/what-is-a-pharmacy-benefits-manager.md"
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last_updated: "2026-07-28T15:54:14-04:00"
---
What Is A Pharmacy Benefits Manager?
What Is A Pharmacy Benefits Manager?
The cost of prescriptions is the fastest growing segment of healthcare cost in the United States, faster than hospital and physician costs combined. It is estimated that in 2015, prescription drug expenditures in the United Stated were approximately $457 billion, representing roughly 16.7% of the overall dollars spent on personal healthcare services.
A pharmacy benefits manager (PBM) is a [third-party administrator (TPA)](https://varipro.com/what-is-a-tpa/) of prescription drug programs. PBMs are contracted by employers to provide prescription drug benefit management for their employees.
PBMs offer a variety of services including
- Processing plan member prescription claims
- Negotiating drug prices with drug companies and pharmacy networks
- Administering mail order and specialty pharmacy channels and claims
- Leverage tools to encourage the use of generics and affordable brands
- Performing drug utilization analysis and reviews
- Developing and managing formularies (a list of preferred drugs covered under a plan)
- Managing high-cost specialty medications for patients with complex conditions
- Implement programs to ensure patient compliance
Benefits to working with a PBM
Cost Savings
PBMs can reduce costs by negotiating discounts with pharmacies and offering cost effective options such as mail order fulfillment. PBM’s steer plan participants to more cost effective drugs through the use of a formulary.
Information & Insights
Employers have access to reports providing drug utilization information which aids in reducing waste and supporting patient adherence to the prescribed drug regimens.
Expertise
PBMs make staying current with changes in the field of prescription drugs easy by keeping employers informed of industry changes in pricing, safety, efficacy and much more.
Choosing a PBM to help manage your prescription claims cost can be challenging. Knowing the right questions to ask PBM candidates will help you choose a PBM that can lower your prescription claims cost.
Questions to ask when selecting a PBM:
- Do they classify brand and generic drugs based on a specified national reporting service?
- Does their definition of a claim only include “paid” claims or do they include “duplicate”, “reversed”, or “rejected” claims?
- Will they disclose and allow regular access to their Maximum Allowable Cost (MAC) list and disclose the discount level for generic drugs not included on their MAC list?
- Will they provide both full disclosure and verification of fulfilling all your PBM obligations, including but not limited to drug formularies, pricing methodologies, MAC and Specialty drug lists?
- Will they define “rebate” as any manufacturer derived revenue related to plan utilization, including but not limited to formulary revenue, market share utilization, administration fees and data fees?
- Will they disclose all manufacturer contracts yielding any payment to you related to member utilization under the plan?
- Will they disclose all sources of revenue directly or indirectly related to the administration of the plan?
- Is the price of the drug that they pay at the pharmacy, the exact same amount the plan sponsor will pay for the drug?
- Will they provide access to all agreements relating to the administration of the plan, including but not limited to pharmacy networks, manufacturer rebates and all claims data?
- Will they allow the plan sponsor to give final approval before any drug may be classified a specialty drug and included on the specialty drug list?
Frequently Asked Questions
**Q: How will employee co-pays be managed?**
A: Working with a PBM ensures that plan participants receive timely information outlining what co-payments to anticipate and who to contact with questions or assistance, if needed.
**Q: How will I know when existing drugs are being transitioned to the generic category?**
A: You can specify the frequency you would like prescription plan updates from your PBM – the more frequent the better, as the drug industry changes rapidly.
Want to Learn More?
Additional SmartSheet topics are available on the [Educational Resources](https://varipro.com/educational-resources/) page.
[](https://varipro.com/wp-content/uploads/2024/09/SmartSheet_What-is-a-Pharmacy-Benefits-Manager.pdf)
---
---
title: "What Is Claims Transparency?"
url: "https://varipro.com/what-is-claims-transparency/"
markdown_url: "https://varipro.com/what-is-claims-transparency.md"
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last_updated: "2026-07-28T15:54:12-04:00"
---
What Is Claims Transparency?
What Is Claims Transparency?
A claim is a request for payment that is submitted by a health care provider for costs of healthcare services and/or supplies provided to a plan participant by a hospital, doctor, or other health care facility. How does transparency relate to that and why is it important?
Claims transparency refers to information available to employers and plan participants that raises awareness and understanding of what activity is occurring with their claims and health plans. Transparency enables employers and ultimately plan participants to discern information such as price, safety and quality, billing accuracy and more.
State and federal regulations require more tracking and sharing of information now more than ever. Traditional health insurance carriers however, are not obligated to share these insights with clients. As a result, employers aren’t always aware of where their money is being spent or how and when their plan participants are using their benefits. Unfortunately, employers have become used to ‘not knowing’ and having incomplete information. The result is paying higher healthcare costs.
[Self-funded](https://varipro.com/wp-content/uploads/2024/09/SmartSheet_What-are-self-funded-health-plans.pdf) health plans on the other hand, facilitated through a [third party administrator (TPA)](https://varipro.com/what-is-a-tpa/) provide accurate, meaningful and usable information to employers on a regular basis. These insights help employers realize available opportunities to enhance their plan, increase cost savings, or influence and educate their plan participants in achieving and maintaining better health.
Transparency in claims serves us all:
Plan Participants
Having access to information on a provider’s price, quality of care and overall safety enables personal decisions of choice with confidence and comfort.
Employers
Transparency improves plan strategy through informed decision making. These insights promote better decision making and provide opportunities.
Healthcare Community
Information available through claims transparency helps nurture a healthy community by driving down costs and promoting high quality standards.
Frequently Asked Questions
**Q: What are the benefits of claims transparency?**
A: Claims transparency promotes fair pricing, provides plan participants with tools to make better care choices, and allows employers to make data supported decisions. Together these attributes help reduce the total cost of healthcare.
**Q: How does working with a TPA optimize the benefits of claims transparency?**
A: Unlike traditional models, the transparency that comes from working with a TPA provides employers with greater access to more meaningful data. TPAs are rooted in the belief that transparency is key to effective decision making.
Want to Learn More?
Additional SmartSheet topics are available on the [Educational Resources](https://varipro.com/educational-resources/) page.
[](https://varipro.com/wp-content/uploads/2024/09/SmartSheet_What-is-Claims-Transparency.pdf)
---
---
title: "What Is Employee Wellness?"
url: "https://varipro.com/what-is-employee-wellness/"
markdown_url: "https://varipro.com/what-is-employee-wellness.md"
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---
What Is Employee Wellness?
What Is Employee Wellness?
What comes to mind when you hear ‘employee wellness’? Employer subsidized weight loss programs? Exercise classes? Employee health evaluations? What’s behind employee wellness and how does it achieve its objective?
Employee wellness is built on the premise that healthy employees have a positive impact on the bottom line in many ways. ‘Healthy employees’ leads to ‘Happy employees’ and often translates to ‘Engaged and Productive’ employees – which is good for business.
The intent of most employee wellness programs is threefold:
- Improve employees health.
- Reduce health risks in employee populations.
- Reduce employee healthcare costs.
Employee wellness specifically addresses common health risks that exist within any given workforce such as stress, obesity, smoking and high blood pressure. It’s already been proven that these risks lead to major health challenges for individual employees and put a financial strain on the employer subsidizing the health plan covering the affected individuals. Adopting an employee wellness program is a proactive way to address these issues and ensure employees have the support they need to correct and adjust behaviors that typically play a role in creating these risks to begin with.
Leveraging in-depth knowledge of healthcare compliance issues and industry trends, your TPA can provide customized reports and guidance to develop and support your wellness initiatives.
Successful employee wellness initiatives are not stand alone programs – they are integrated within the company’s culture. To change employee health habits, you need to start with your company’s culture – setting everyone up for a healthy tomorrow.
There are several elements that an employer can leverage to help ensure employee acceptance of and participation in the company’s wellness initiatives. Below we have outlined three of the most impactful.
Simple, Transparent Objectives
Clear and frequent communication that shares program objectives helps employees understand the ‘why’ behind the program. It is important that employees know how it will work, how they can become involved and the benefits to them (emotional, physical, and financial) as well as the organization. Transparent objectives can also help build trust and motivation with employees.
Communication
Successful wellness programs actively include the employees in the design of the program. They leverage multiple communication channels like focus groups, ongoing feedback, and employees co-leading the program to help ensure ‘ownership’ and ‘sustainable engagement’.
Create a Supportive Environment
Leaders should not underestimate the power of peer, coworker and family influence and support. The opportunity to include spouses and family members in wellness programs has been shown to increase participation and engagement. Programs should also provide employees the opportunity to personalize wellness goals that are applicable and achievable for their individual needs and generational differences. Programs targeting a ‘one-size-fits-all’ specific health goal have been shown to be less successful than those programs offering individual personalization.
Frequently Asked Questions
**Q: What can I do as the employer to encourage active participation in our wellness program?**
A: Very simply and low cost – participate in the program yourself. Share your reasons for participating, encourage others to participate, and celebrate results regularly. This will send a powerful message to your employees that shows you care about their well-being!
**Q: What could be a simple, fun way to engage my employees to be more active in the workplace?**
A: If your workplace has multiple floors, make the stairwells fun to be in. Encourage employees to decorate the walls with fun, lively graphics making the stairway an enticing alternative to the elevator. For more ideas, search “employee wellness ideas” online.
Want to Learn More?
Additional SmartSheet topics are available on the [Educational Resources](https://varipro.com/educational-resources/) page.
[](https://varipro.com/wp-content/uploads/2024/09/SmartSheet_What-Is-Employee-Wellness.pdf)
---
---
title: "What is Level Funding?"
url: "https://varipro.com/what-is-level-funding/"
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---
What is Level Funding?
What is Level Funding?
Through the evolution of health care, providers have determined their own prices. The result is a broad range of price variances from one provider to another! The price of a procedure (big or small) will vary simply depending on where the procedure is taking place and who is performing it.
It’s no secret the high cost of health care has many employers feeling limited in their options and ability to provide quality benefits at an affordable cost. Several options exist beyond simply shifting costs to employees. One such option is reference-based pricing (RBP). RBP helps address the cost of care while also addressing employer concerns regarding the affordability of health care benefits.
What is reference-based pricing?
Reference-based pricing is a health plan strategy where the employer sets a ceiling on the amount it will cover for a procedure rather than having the provider determine the cost. Providers are then asked to accept the RBP payment, or provide justification as to why their fees exceed reasonable and customary charges.
To achieve optimal results for both the employer and member, integrating RBP in health coverage requires specialized administrative capabilities best served by [third party administrator (TPA)](https://varipro.com/what-is-a-tpa/) organizations.
Health plan coverage rarely covers the full amount of any procedure. Cost is typically covered by a combination of funding such as co-pays, deductibles, plan coverage, Medicare or Medicaid.
Here’s how reference-based pricing works
1. Health care providers charge drastically different prices for the same procedure.
2. Each geographic market has an established “reasonable and customary” price for that procedure.
3. TPAs use reasonable and customary (ie. reference-based) pricing to negotiate with providers to ensure that their employer and member clients are not over-charged.
Example of cost variance: MRI
For example, the cost variance of an MRI might range between $800 and $4,000 or more. However, the quality of the procedure and care provided is basically the same. RBP eliminates the variance with a set amount and ensures a win/win/win scenario:
- The patient receives quality care at a more affordable cost.
- The provider receives fair payment for their services.
- The premiums begin to stabilize for the employer and employees.
Are there advantages of level funding?
The objective is simple – address healthcare costs for individual employees and employers. The benefits of RBP however have a far reaching, ripple effect throughout the healthcare community. The intent is to provide an effective tool to help stabilize the cost of healthcare.
Information & Insights
Clients receive claim information on a regular basis indicating how claim funds are being spent. TPA shares valuable insights with data while identifying plan updates and employee education opportunities.
Budget Friendly
Monthly payments mean budget control with no fluctuation due to claim payments.
Low Risk
Plans are customized to meet specific financial goals while the addition of stop-loss coverage reduces risk throughout the policy year.
Flexibility
No ‘off the shelf’ plans with level funding, each plan is customized to meet specific client needs.
Frequently Asked Questions
**Q: What kinds of companies are best suited for level funding?**
A: Level funding works best for companies that are:
- Interested in the cost saving attributes of self-funding but don’t want the risk of unpredictable, big hit claim costs.
- Engaged and active in promoting and maintaining a culture of health and wellness.
- Small to mid-sized with 50 or more employees.
**Q: How exactly does reimbursement work?**
A: If, at the end of the policy year, the total dollars spent on claims is less than the total monthly premiums paid, clients receive a refund check for the overage or apply the amount in renewing their policy. If the opposite is true, stop-loss coverage kicks in and protects clients from having to pay the balance difference.
Want to Learn More?
Additional SmartSheet topics are available on the [Educational Resources](https://varipro.com/educational-resources/) page.
[](https://varipro.com/wp-content/uploads/2025/06/SmartSheet_What-is-Level-Funding_v02.pdf)
---
---
title: "What Is Reference-Based Pricing?"
url: "https://varipro.com/what-is-reference-based-pricing/"
markdown_url: "https://varipro.com/what-is-reference-based-pricing.md"
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last_updated: "2026-07-28T15:54:07-04:00"
---
What Is Reference-Based Pricing?
What is Reference Based Pricing?
Through the evolution of health care, providers have determined their own prices. The result is a broad range of price variances from one provider to another! The price of a procedure (big or small) will vary simply depending on where the procedure is taking place and who is performing it.
It’s no secret the high cost of health care has many employers feeling limited in their options and ability to provide quality benefits at an affordable cost. Several options exist beyond simply shifting costs to employees. One such option is reference-based pricing (RBP). RBP helps address the cost of care while also addressing employer concerns regarding the affordability of health care benefits.
What is reference-based pricing?
Reference-based pricing is a health plan strategy where the employer sets a ceiling on the amount it will cover for a procedure rather than having the provider determine the cost. Providers are then asked to accept the RBP payment, or provide justification as to why their fees exceed reasonable and customary charges.
To achieve optimal results for both the employer and member, integrating RBP in health coverage requires specialized administrative capabilities best served by [third party administrator (TPA)](https://varipro.com/what-is-a-tpa/) organizations.
Health plan coverage rarely covers the full amount of any procedure. Cost is typically covered by a combination of funding such as co-pays, deductibles, plan coverage, Medicare or Medicaid.
Here’s how reference-based pricing works
1. Health care providers charge drastically different prices for the same procedure.
2. Each geographic market has an established “reasonable and customary” price for that procedure.
3. TPAs use reasonable and customary (ie. reference-based) pricing to negotiate with providers to ensure that their employer and member clients are not over-charged.
Example of cost variance: MRI
For example, the cost variance of an MRI might range between $800 and $4,000 or more. However, the quality of the procedure and care provided is basically the same. RBP eliminates the variance with a set amount and ensures a win/win/win scenario:
- The patient receives quality care at a more affordable cost.
- The provider receives fair payment for their services.
- The premiums begin to stabilize for the employer and employees.
Why is reference-based pricing beneficial?
The objective is simple – address healthcare costs for individual employees and employers. The benefits of RBP however have a far reaching, ripple effect throughout the healthcare community. The intent is to provide an effective tool to help stabilize the cost of healthcare.
Employees
RBP takes guesswork and worry from employees regarding price – specifically, out of pocket costs. It also encourages members to engage proactively in managing their healthcare costs.
Employers
Managing cost is a primary motivator of employers choosing self-funded health plans. RBP leverages every opportunity to proactively achieve optimal cost management while still providing quality health care to members.
Healthcare Community
Setting fair value pricing through RBP helps create a competitive market focused on improved results through quality performance at an affordable cost.
Frequently Asked Questions
**Q: How will reference-based pricing affect my employees?**
A: Plan members must be informed and engaged throughout their healthcare experience to ensure the right coverage outcome. Asking questions about the cost of a procedure is encouraged. Staying informed about providers who are RBP compliant is recommended. Patients still have a choice in using non-compliant providers but in doing so assume responsibility for the balance beyond the cost ceiling set by RBP.
**Q: What happens if employees face emergency situations?**
A: Reference-based pricing is one tactic within an employer’s health plan provisions. Emergency situations are covered per the provisions of an employer’s full plan benefits – so members should always follow the established protocol for an emergency or life-threatening situation. In many cases, reference-based pricing can still have a positive impact in managing costs associated with emergency care as third party administrators provide patient advocacy assistance in these situations.
Want to Learn More?
Additional SmartSheet topics are available on the [Educational Resources](https://varipro.com/educational-resources/) page.
[](https://varipro.com/wp-content/uploads/2024/09/SmartSheet_What-is-reference-based-pricing.pdf)
---
---
title: "What is Stop Loss Insurance?"
url: "https://varipro.com/what-is-stop-loss-insurance/"
markdown_url: "https://varipro.com/what-is-stop-loss-insurance.md"
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last_updated: "2026-07-28T15:54:05-04:00"
---
What is Stop Loss Insurance?
What is Stop Loss Insurance?
If the idea of saving money by offering self-funded health benefits to your employees appeals to you but the RISK of paying out large, unexpected or unplanned claims concerns you . . . you will be happy to know this.
Stop-Loss insurance is a policy that works in conjunction with self-funded health plans. It is an insurance product that provides protection to employers from the financial risk of catastrophic or unpredictable high cost and/or high volume of claims filed under the plan. Stop-loss coverage protects against claims that could compromise the company’s financial health at any given time.
Types of Stop-Loss Insurance Coverage
Stop Loss insurance is typically purchased by the employer through a [TPA](https://varipro.com/what-is-a-tpa) or directly from a carrier underwriter. Working with these experts, an employer can determine their threshold of claim payment risk and thereby set the desired level of protection needed.
Specific: protection for high claims on any one individual member.
Aggregate: protection that establishes a ceiling on the amount of total expenses during a contract period.
Frequently Asked Questions
**Q: How does Stop-Loss work?**
A: A TPA can source a Stop-Loss insurance carrier who will assist an employer in setting risk limits and terms of a policy. TPA’s coordinate the policy’s premium payments to the carrier as well as provide administrative services in managing Stop-Loss claims as they occur.
**Q: How beneficial are claim reports provided by a TPA?**
A: Federal regulations require TPA’s to track and provide reports to clients. These company-specific reports are updated regularly and contain actionable information that can identify cost savings, guide plan customization and wellness strategy of an employer.
Want to Learn More?
Additional SmartSheet topics are available on the [Educational Resources](https://varipro.com/educational-resources/) page.
[](https://varipro.com/wp-content/uploads/2025/06/SmartSheet_What-is-Stop-Loss-Insurance.pdf)
---
---
title: "About TPAs"
url: "https://varipro.com/about-tpas/"
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---
About TPAs
About TPAs
**What is TPA or a Third Party Administrator?** In brief, a TPA or Third Party Administrator is a business that handles the claims, processing, and reporting components of an employee and retiree benefits plan. But in order to better understand TPA or third party administration, let’s first address what it is in context of self-funding an employee benefit plan.
**What is self-funding?** In self-funding, employers underwrite the risk and act as their own insurance company. In return for accepting greater risk, employers aim to reduce costs. Self-funding also lets employers gain more flexibility and insight in regard to their coverage. They can more fully understand how each claim dollar is spent with more detailed, customized, and timely reporting. Employers can respond to changing coverage needs more quickly. A self-funded employer is often better equipped to control costs by decreasing operational fees while gaining tax savings.
**What is stop-loss?** A self-funded employer will only want to assume a tolerable amount of risk. The balance of risk can be transferred to a stop-loss reinsurance policy. This helps guard against the unknown. Varipro offers deep knowledge and insights of the stop loss markets. We can help you through the often confusing process of securing stop loss coverage. Varipro maintains longstanding relationships with National (US) reinsurance carriers with the highest ratings and reliability. Many levels of Specific and Aggregate coverage are available depending on your business needs, claim history, and risk tolerance levels. Get a competitive rate for your group.
**So what does a Third Party Administrator (TPA) do?** A self-funded employer will often partner with a third-party administrator (TPA). The TPA can take care of tasks like enrollment, claim processing, premium collection, COBRA notifications, utilization reporting, and more. Because Third Party Administrators specialize in benefits administration, they are more cost effective and responsive than in-house processing. A sole focus on benefits administration lets a TPA keep their clients informed about utilization and compliance issues.
---
---
title: "What is a TPA?"
url: "https://varipro.com/what-is-a-tpa/"
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last_updated: "2026-07-28T15:54:02-04:00"
---
What is a TPA?
What is a TPA?
If you’re considering self-funded benefit plans then you no doubt have added “What is a TPA” to your list of topics to research. This SmartSheet is dedicated to defining and explaining the role of a TPA – Third Party Administrator.
TPA stands for **Third Party Administrator** and as such is defined as an organization or individual that handles the claims, processing, and reporting components of a self-funded health benefits plan.
As an employer considers or maintains a [self-funded health plan ](https://varipro.com/wp-content/uploads/2024/09/SmartSheet_What-are-self-funded-health-plans.pdf)program they typically will engage the services of a TPA. Using tools and knowledge of the industry, TPA consultants can determine if self-funding is a viable option for the client.
TPA’s are professional, state-licensed organizations offering comprehensive services. They are considered experts in saving money for employers and in directing the customization of coverage. TPA’s are on the cutting edge of government compliance, laws and legislation affecting employee benefit plans.
TPA’s may be independently owned and operated, owned by an insurance company, multi-employer group, or even by hospitals. They work on behalf of employers with the broad variety of outside vendors involved in the health care provider industry.
Some TPA’s work directly with an employer – others might work through agents and/or consultants.
Are there Benefits of hiring a TPA?
Absolutely! Whether developing or implementing a self-funded health plan, TPA’s offer a variety of benefits!
Cost Savings
Cost savings and increased cash flow for clients can be expected in a TPA’s work, from planning through administering the plan, record keeping and reporting, enrollment and eligibility management to name a few.
Information & Insights
Clients have access to reports relative to costs, claim history, and more. This enables informed decision making and plan adjustment as needed.
Expertise
TPA’s have extensive knowledge and expertise in the healthcare industry, regulatory requirements, adjudicating claims, account management and customer/member service needs.
Services / Skill Set of TPA’s
Every TPA is unique in their culture, area of specialty and more. This list represents a compilation of skills and services of TPA’s in general.
- Access to real-time eligibility and claims history reports
- Accounting Support and Reconciliation
- Billing Services
- Eligibility Management & Communication
- Claim Adjudication and Auditing
- Case Management and Utilization Reviews
- Customer Service/Call Center
- Plan Setup and Summary Plan Descriptions
- Enrollment Materials and Member Education & Communication
- Identification Card Production
- Report Customization
- Coordination of Documentation for [Stop-Loss](https://varipro.com/what-is-stop-loss/) claims
- Health Planning & Industry Expertise
Frequently Asked Questions
**Q: What differentiates one TPA from another?**
A: No two TPA’s are identical. Services offered and areas of specialty may vary as will rates so it’s necessary to examine and align with a TPA suitable to an organization’s needs. Customer service level and willingness to practice engaged management also play a role in finding a TPA that ‘fits’ the culture and expectations of an employer.
**Q: What is meant in referencing ‘engaged management’?**
A: Engaged management refers to the ability and commitment in how a TPA approaches the work an organization hires them to do. Do they dictate a healthcare plan strategy and direction or work with clients as business partners in assessing needs and capturing cost advantages? Relationship building, coaching and educating clients are often invisible traits but should be part of the conversation when seeking out a TPA.
Want to Learn More?
Additional SmartSheet topics are available on the [Educational Resources](https://varipro.com/educational-resources/) page.
[](https://varipro.com/wp-content/uploads/2024/09/SmartSheet_What-is-a-TPA.pdf)
---
---
title: "HIPAA"
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HIPAA
HIPAA
The primary right you have under the HIPAA privacy rule is control over how your personal information is used or disclosed.
HIPAA stands for the Health Insurance Portability and Accountability Act, signed into law in 1996. This is protective legislation which provided portability of important benefit rights and increased accountability for the disclosure of personal health information by those who collect such information in the performance of their services to you.
The first phase of the law’s application provided ways to reduce or eliminate the pre-existing condition, benefit waiting period when changing medical plans. This makes the benefit eligibility you have achieved for continuing health conditions portable between medical plans when you have been covered in a creditable health plan for 18 months or more without a break in coverage. (Specific rules apply.) The result of this portability is the reduction or full elimination of the period of time over which you must wait to receive benefits for a pre-existing condition. HIPAA legislation also established that pre-existing condition waiting periods could not be longer than 12 months. A letter of Creditable Coverage should be obtained from the plan administrator each time you leave a medical insurance plan for use in applying for new coverage.
Along with the portability protection described above, the law further includes provisions for obtaining individual coverage from eligible insurers who must not reject your request so long as you have completed certain obligations, including exhausting all COBRA Continuation of Coverage rights.
The second phase of HIPAA rules were designed to protect you and protect the security of your personal health information. The law assures you numerous rights regarding your health coverage and medical information, but the Privacy Rule specifically addresses your right to keep protected health information secure and limited to only the people who need to see it.
HIPAA provides the following rights:
- Right to obtain copies of your health information
- Right to request amendment to your information
- Right to an accounting of disclosures of your health information
- Right to request restrictions to those accessing your health information
- Right to alternative confidential communications
- Right to make a privacy complaint
Check the privacy notice provided to you by your health care provider or health plan for details on how to exercise any of these rights. Varipro has provided each of their client companies with a signed Business Associate Agreement pledging HIPAA security compliance and accountability for protecting all Personal Health Information. Retirees whose fully insured plans are administered by Varipro are also provided with a Security Authorization and Revocation Agreement wherein they may designate and/or revoke the names of individuals who may ask for and receive protected personal health information.
[Click here to obtain more information about](http://www.hhs.gov/hipaa/)
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Privacy & Legal
Privacy & Legal
**LEGAL TERMS AND CONDITIONS**
The content of this site is provided for lawful purposes only. Unless otherwise stated herein: 1) permission is given to view, print and use the content in this Site only for your personal, non-commercial home use, provided that no copyright, service/trademark, or other proprietary notices which accompany any such content are deleted or changed; 2) content in this Site may not be copied, reproduced, transmitted, displayed, downloaded, uploaded, posted, distributed, rented, sublicensed, altered, stored for subsequent use, or otherwise used in whole or in part in any manner without Varipro’s prior written consent; 3) use of the content in this Site for any other purpose violates Varipro’s intellectual property rights; and 4) nothing in this Site will be construed as conferring any license for Varipro or any third party’s intellectual property rights.
Any attempt by any person to deliberately damage this web site or undermine its operation is a violation of criminal and civil laws and, should such an attempt be made, Varipro reserves the right to seek damages from such person to the full extent permitted by law.
**LINKS**
Links to other Web sites. Your use of links from this site to other Web sites is voluntary. They are provided for your convenience as Internet navigation tools only. Varipro accepts no responsibility for the content, products and/or services provided at such Web sites. Links to other Web sites contain information created, published, maintained, or otherwise posted by persons or entitles independent of Varipro. Varipro does not endorse, approve, recommend, favor, certify, or control these Web sites, and does not guarantee the content, accuracy, completeness or timeliness of information located at such Web sites. The owners/operators of such other Web sites do not necessarily endorse Varipro products or services, nor are they responsible for the content of this Site. Use of any information, products or services obtained from Web sites with links to this Site is voluntary, and entirely at your own risk.
[Download Varipro Privacy Notice](https://varipro.com/wp-content/uploads/2026/04/Varipro-Privacy-Notice-Final-Edition.pdf)
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