Financial Guidance

Group Health Insurance

Health Plan Strategies For A Dynamic Market*

Self-Funded Plan Option

By sponsoring one’s own health plan, an employer can remove his group from the myriad of burdens placed upon high risk groups in the public marketplace. In this day and age, regulation of health plans is at an all time high; but through plan sponsorship, employers can remove themselves from taxing regulations, and often save thousands of dollars, preserving valuable benefits for employees while using strategic plan designs to protect from penalties under reform.

With with our partner's Self-Funded Exchange Marketplace, we support the employer’s ability to sponsor their own benefit plan through a self-funded plan, with all the protections in stop-loss and administrative support that an employer needs. Through comprehensive analysis, expertise, and planning, we first provide a solid recommendation regarding the choice between fully-insured plans and self-funded plans. Once we know whether self-funding is the best option for you, we can engage in some simple strategic planning to be sure your benefits meet your budget needs, and are those your employees need.

Don’t let a lack of information leave you wondering if you can find a better deal. With the Self-Funded Exchange, we’ll gather the required information, perform analysis, and make a recommendation that you can count on!

Among the benefits of self-funding, the following elements highlight potential advantages that cannot be ignored:

  • Composite Rates: Simplify Defined Contribution

  • No PPACA Rebate Reporting: Keep the Claims Savings in the Plan

  • Standard Benefits Across State Lines: No need for multiple plans across state lines

  • Rates You Deserve: Earn better rates for deserving groups

How Self-Funding Works

Self-funded health benefit plans give employers and their employees added protection against spiraling health care costs, especially in light of the Patient Protection and Affordable Care Act (PPACA).

Unlike the traditional health benefits plan model, costs are controlled by the employer – not an insurance company. Employers set the level of benefits they wish to offer and the cost for employers each year.

Costs of self-funded plans are similar to an insurance premium and include administration fees and all medial claims costs, as well as stop-loss premium payments. Stop-loss insurance limits a company’s exposure on medical costs to a set level.

Employees are charged a set monthly fee, established by the employer sponsoring the health plan benefits. The employer pays the medical claims costs incurred by the covered persons enrolled in the plan. These costs are different each month, depending on the cost of care paid for covered persons. If claims costs exceed the catastrophic claims level established for the policy, then stop-loss insurance reimbursements are made to the employer.

If medical costs do not reach the annual amount budgeted, then the employer can collect a refund on the unused medical costs. Historically, about half of companies obtain refunds.

*Health plan services provided in conjunction with a strategic alliance relationship