This case study highlights the operational overhaul of a 13-state MEWA, where transitioning to fully insured status and renegotiating vendor agreements eliminated burdensome regulatory risks and secured significant compliance savings.
Transforming a Multi-State MEWA
Client: 13-State Multiple Employer Welfare Arrangement
Client Operating a 13-State Multiple Employer Welfare Arrangement (MEWA), comprised of housing associations serving affordable housing needs, previously self-funded its group health plan via a Voluntary Employees’ Beneficiary Association (VEBA) trust. Treated as an insurance company in many states, it faced burdensome compliance with varying regulations, risking operational extinction despite exceeding 500 participants—the threshold where self-funding typically saves costs. Hall Benefits Law (HBL) recommended and facilitated a switch to fully insured status, negotiating vendor agreements for savings and reducing obligations, resulting in a more efficient plan with annual participation growth and critical updates ensuring compliance.
THE CHALLENGE
As a self-funded MEWA, the client incurred high costs and efforts complying with diverse state insurance laws, including HIPAA and protected health information handling. Despite the general rule favoring self-funding for large plans, the multi-state operations amplified complexities, diverting resources from core missions like affordable housing and employee benefits.
THE TURNING POINT
Faced with escalating compliance burdens threatening viability, the client needed expert analysis to evaluate alternatives. Conventional advice would retain self-funding, but a deeper review revealed fully insured as optimal, prompting HBL’s engagement to guide the transition and negotiations.
THE SOLUTION
HBL partners Anne Tyler Hall and Tim Kennedy researched the MEWA’s resources, claims history, and operations, concluding fully insured status would save money and time. They negotiated vendor contracts for cost reductions, shifted major compliance (e.g., HIPAA) to the insurer, and minimized state law requirements, strengthening the plan’s focus on participant needs.
Our Results
Cost and Compliance Savings
Reduced expenses and efforts by becoming fully insured, avoiding insurance-like state regulations.
Vendor Negotiations Success
Secured significant savings through renegotiated agreements, enhancing efficiency.
Participation Growth
Boosted annual enrollment since 2020, making the plan more attractive and viable.
Mission Enhancement
Freed resources for affordable housing goals, with annual updates maintaining compliance—no other firm recommended this counterintuitive shift.
WHY IT MATTERS
Large MEWAs often default to self-funding, but tailored assessments can reveal better paths like full insurance for multi-state entities. This case shows how innovative ERISA counsel can cut costs, simplify compliance, and refocus on missions, challenging norms to deliver client-specific wins in complex benefits landscapes.
ABOUT HBL
Hall Benefits Law (HBL) is a boutique ERISA and employee benefits law firm helping employers design and defend retirement and health plans. With offices nationwide, HBL advises on M&A benefits, ESOPs, executive compensation, and compliance, and drives savings and transparency through TPA and PBM negotiations. Firm clients have realized over $400MM+ in penalty abatements and multimillion-dollar annual plan savings.