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2017 by Core Employee Benefits

Alternate Funding Plans

Small Group Partially Self-funding

With the changing times of health insurance and the passing of the Affordable Care Act, the landscaping or purchasing health insurance has changed quite dramatically. Once available only to very large employer, self-finding is available to much small group. They are ERISA based plans which allow the group to participate in part of the cost of the claims. This experience allows them to be more active in managing their healthcare assets and help to control more of the aspects of their healthcare plan. 

Plans can be set-up a number of different ways with protections built in to feel more like a traditional fully insured plan or built piece by piece and take more advantage of the cash flow of claims. There is stop-loss insurance that is put in place to deal with the overall claim amount on the entire group and also a specific stop-loss for individual claimants having large claims that exhaust the claim fund. By separating out admin cost, prescription management, claim management, stop-loss insurance and other fixed costs groups cane more specifically tailor a plan that brings the best value for them.

Is self-funding for all groups? Not everyone will benefit from using an alternate funded (partially-self funded) plan. Some groups who have large overall claim costs may not benefit from this approach, and those who do not which to take a more active approach to their healthcare assets may not be a great fit. We are happy to discuss the specifics of any group to see if it may be a good fit for them.

 

Mid to Large group self-funding

Working with groups of 50 to 1000+ employees with self-funding to help create a long term strategy can be complicated, but we work to make it as simple as possible for employers. We work with several TPA's, Marketing Organizations, Pharmacy Benefit Managers, Stop-loss Insurers, etc to help create a symphony of benefits that work together for the employers long term strategy. Being able to leverage technology and examine the data we are now more than ever able to actively manage a plan to increase value to the employer and employees. By controlling the variables we put into the management of a plan can have very positive effect on the claims which in turn helps significantly helps the employer is participating in the claim fund. 

 

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