This case study details how rigorous contract negotiations and a focus on fee transparency achieved consistent savings for health plan sponsors, uncovering concealed charges and strengthening fiduciary protections against breach claims.
Unmasking Hidden Fees
Client: Group Health Plan Sponsors
Group Health Plan Sponsors, acting as ERISA fiduciaries for various employer-sponsored health plans, must ensure service provider fees are reasonable but often face concealed direct and indirect charges from third-party administrators (TPAs) and pharmacy benefit managers (PBMs). This opacity hinders fee monitoring and exposes sponsors to breach lawsuits for excessive payments. Hall Benefits Law (HBL) partners Tim Kennedy and Anne Tyler Hall conducted rigorous negotiations across dozens of contracts, focusing on transparency, savings, and fiduciary protections, resulting in consistent fee reductions beyond broker achievements and deterrence against plaintiff claims.
THE CHALLENGE
Under ERISA, sponsors can only engage providers with “reasonable” fees, yet TPAs and PBMs frequently hide total costs, preventing accurate assessments. This risks fiduciary breaches, lawsuits from participants alleging overpayments, and financial inefficiencies, especially when brokers fail to secure optimal terms.
THE TURNING POINT
Recognizing that even major providers could be challenged, Group Health Plan Sponsors sought specialized ERISA negotiators to uncover hidden fees and renegotiate contracts. Without intervention, sponsors faced persistent overpayments and legal vulnerabilities, leading to HBL’s involvement for a proactive, multi-client approach.
THE SOLUTION
HBL’s team, led by Tim Kennedy and Anne Tyler Hall, applied a structured negotiation process emphasizing contract language clarity, fee disclosures, and savings. They confronted providers of all sizes, leveraging ERISA requirements to demand transparency and reductions, consistently outperforming broker-negotiated deals while enhancing fiduciary safeguards.
Our Results
Fee Reductions Achieved
Generated savings beyond broker levels in every negotiation, reducing overall plan costs across dozens of matters.
Transparency Enhanced
Unmasked hidden direct and indirect fees, enabling accurate reasonableness determinations under ERISA.
Lawsuit Deterrence
Strengthened fiduciary protections, deterring potential breach suits from plaintiffs targeting excessive fees.
Broad Impact
Delivered results for multiple sponsors, establishing a model for ongoing compliance
and efficiency.
WHY IT MATTERS
Hidden fees in health plans erode fiduciary duties and invite litigation, but aggressive, ERISA-focused negotiations can restore transparency and savings. This case underscores the need for expert advocacy to empower sponsors, outperform standard brokers, and protect against regulatory and legal risks in an increasingly scrutinized benefits landscape.
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.