Tribal Self-Insured Health Plans PayOr of Last Resort

1. Presented by: Tyler Moore, Mattecheck & Associates and Face Rock Enterprises Tribal Self-Insured Health PlansPayOr of Last Resort

2. Under 25 U.S.C § 1623(b) the Tribe becomes the payer of last resort for claims incurred by a Contract Health Services (CHS) eligible member/employee • All other coverage would be primary including: • Coverage under a spouse’s health plan • Coverage under Medicare • Coverage under Medicaid PayOr of last resort - Overview

3. Positively impacts the CHS and Health Plan budget by shifting claims cost to other payers without impacting the members out-of-pocket (both the Tribal Member Plan and the Employer Sponsored Plan) • Impact varies drastically based on: • Number of CHS eligible employees • Number of Tribal Members who have other coverage payOr of last resort – Financial Benefit

4. The Tribe’s health programs must be self-funded • The health plan documents must have the correct language included • The Tribe and/or the health plan third party administrator (TPA) must correctly manage eligibility • The Tribe’s TPA must understand how to apply and enforce the Payor of Last Resort PayOr of last resort – key features

5. Partner with a subject matter expert to help set up and manage the Tribe’s health programs • Find the right third party administrator (TPA) • Conduct a coordination of benefit (COB) audit • Provide Tribal Member assistance – enrolling in Medicare/Medicaid Payor of Last Resort - considerations

6. Questions? Tyler Moore tmoore@mattecheck.com (541) 504-4139 Payor of Last Resort – Questions?