Do You Need a TPA?

Employee benefits are a key factor for any businesses, helping attract top talent, boost satisfaction, and drive engagement. Yet, managing benefits can be complex and time consuming, creating major challenges for businesses—which is why nearly 50% of employers still don’t offer them. Between navigating regulations, processing claims, and designing cost-effective plans it can all feel overwhelming, especially as healthcare continues to evolve.

That’s where third-party benefits administrators (TPAs) step in. They simplify the process by taking care of the busywork and allowing you to focus on growing your business. A TPA doesn’t just reduce the headaches of managing benefits—it makes offering them possible in the first place. Companies that work with TPAs often experience reduced healthcare costs, improved employee engagement, and greater operational efficiency. With alternative models and self-funded plans, businesses that previously thought they couldn’t afford to provide benefits can now compete with larger organizations. 

But what exactly is a TPA, and do you really need one? 

What is a TPA in healthcare?

Like the name suggests, a third-party benefits administrator primarily handles the administrative side of employee benefits. That means taking responsibility for important tasks like claims processing, compliance management, and benefits plan design. Benefits administrators become the crucial link between employers, employees, and healthcare providers. Their role is indispensable in creating efficient, cost-effective benefits programs.

Claims Processing: involves handling the entire lifecycle of claims to ensure they are managed efficiently and accurately, which allows employees to access care without unnecessary and frustrating delays. 

Compliance Management: involves helping businesses navigate complex healthcare laws to minimize the risk of penalties. 

Benefits Plan Design: allows benefit administrators to work with businesses to create tailored plans that align with company goals, and possible budgetary constraints.

One of the primary distinctions between TPAs and insurance companies is their independence. Benefit administrators are not tied to a single provider or carrier, which means they have the flexibility to help businesses create customized plans. It’s important to note that a TPA is not an insurance carrier, and they do not directly provide coverage. Rather, a benefits administrator works with their clients to build and manage their healthcare benefits plans.

The growing need for benefits administrators

Managing employee benefits has become increasingly complex due to rising healthcare costs and ever-evolving regulations. For many businesses, particularly small and medium-sized companies, handling these challenges in-house is not practical. Benefits administrators provide the expertise, flexibility and affordability necessary to navigate this while offering significant advantages to employers by allowing them to build self-funded benefits plans. 

Guidance from the Experts 

Healthcare regulations and compliance requirements are constantly changing, making it difficult for businesses to stay up-to-date. This is where a TPA’s experience in managing benefits programs and ensuring compliance with complex federal regulations comes in handy. Instead of tackling these challenges alone, businesses can rely on their benefits administrator to manage those important details, reducing the constant administrative strain and lowering their risk of mistakes. 

Without a TPA, businesses would be stuck with minimal options that are unaffordable and impossible to understand. By working with a TPA, businesses can take a more practical approach to benefits administration—offering self-funded plans, gaining expert guidance, customizing plan options, and keeping costs under control while still providing quality healthcare options for their valued employees.

How Planstin stands out as a TPA

At Planstin, we're not just another third-party administrator—we redefine what benefits administration can be. With a mix of user-friendly technology, personalized support, and flexible solutions, we make managing employee benefits simple and stress-free.

In-House Support & Technology

Our job is to make life easier for our clients and ensure their employees feel supported- whether it’s through our easy-to-use technology, 1:1 guidance, or our hands-on care coordination services. At Planstin, we provide these services at no extra cost for our clients, in addition to the flexibility, affordability, and expert guidance expected from a TPA. Plus, our in-house support, customized solutions, and wide range of benefit options ensures businesses, and their employees, get the care they need. 

We know that managing employee benefits can be overwhelming. That’s why we offer more than just average administrative support. Unlike TPAs that simply process paperwork, we take a hands-on approach with benefit advocacy, streamlined enrollment, educational resources, and compliance support.

Planstin makes open enrollment and benefits management stress-free with our Enrollment Manager, a tool designed to simplify the process for employers, HR teams, and employees alike.

This user-friendly platform helps businesses stay organized and gives employees the clarity they need to make informed decisions about their healthcare. At the end of the day, our goal is to take the hassle out of benefits so businesses can focus on what they do best.

Benefits Solutions

Planstin specializes in creating benefits programs tailored to the needs of businesses rather than forcing them to fit into predetermined, one-size-fits-all insurance models. We offer the kinds of things you’d expect: dental, vision, comprehensive care. But we also offer the kinds of things you might not, such as Direct Primary Care (DPC) memberships and HealthShare memberships. This unique approach—combining traditional and nontraditional solutions, is what separates Planstin from other TPAs.

Preventive care and wellness are also key components of what we offer. We can help your employees gain access to mental health resources, wellness management and other tools that support long-term health and well-being. With simplified processes and personalized care coordination, employees can feel confident navigating their benefits.

The employee advantage

A great benefits program isn’t just about checking a box, it’s about making life easier for employers and employees.  Depending on the TPA, they can provide significant value to employees, transforming the employee experience by offering benefits that actually work for them. When employees have the freedom to choose their healthcare providers and customize their benefits options they feel more in control of their healthcare decisions.

When you partner with a TPA it tells your employees that you take their benefits plan seriously. Showing your employees that you care can win you favor with your team and boost morale. When employees feel supported and valued, it leads to increased productivity and a more engaged workforce. A win for everyone. Employees also benefit from better access to care, education resources, and a sense of security knowing their healthcare needs are covered. These advantages translate into a healthier, happier workforce and contribute to the overall success of the business. 

“I highly recommend considering Planstin Administration as a way of approaching healthcare benefits for a wide range of coverage needs, with minimal out-of-pocket costs for your employees and business budget.”

Ashlee Hogancamp - Founder, Herban Market