In this episode of Blueprints for Better Benefits, Rodney Mattos Jr. and Rodney Mattos Sr. unpack what legal teams need to know about self-funding, especially the responsibilities many employers misunderstand or address too late.
From ERISA fiduciary duties and plan documents to HIPAA oversight, vendor contracts, and non-discrimination testing, this episode explains what legal teams, HR leaders, CFOs, and decision-makers need to know to reduce risk and build a plan that holds up when it matters most.
Topics We Cover
- Why the employer remains the plan sponsor and fiduciary in both fully insured and self-funded plans
- What legal teams should review before a self-funded plan is implemented
- Why generic or outdated plan documents can create avoidable exposure
- How appeals processes, discretionary authority, and employer override clauses work
- What to look for in TPA, PBM, stop-loss, and vendor contracts
- How HIPAA compliance and business associate agreements should be managed
- Why Section 105(h) non-discrimination testing matters
- How captive governance and fiduciary liability coverage help protect employers
Key Takeaway
Self-funding is not just a financial strategy. It is also a legal, fiduciary, and governance decision. When the right structure is put in place from the beginning, employers gain more clarity, more control, and a stronger foundation for protecting both the plan and the people it serves.
Explore More
- Visit the full podcast website, The Rodney Mattos Show: https://rodneymattos.com/
- Explore our insurance agency, Triforta: https://www.triforta.com/
- Learn more about our software for insurance agencies, Apeironix: https://apeironix.com
Connect with Rodney
Email: rmattos@triforta.com
LinkedIn: https://www.linkedin.com/in/rodneymattos/