Self Funding Group Health Plans Presented by Brenda Fagan Johnson.

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Presentation transcript:

Self Funding Group Health Plans Presented by Brenda Fagan Johnson

What is Self Funding? Alternative to conventional group health insurance. Alternative to conventional group health insurance. Employer pays claims instead of premium. Employer pays claims instead of premium. Stop loss provides coverage for catastrophic losses. Stop loss provides coverage for catastrophic losses.

Who Should Consider Self Funding? Employers with 50 or more who are interested in: Employers with 50 or more who are interested in: Managing and reducing healthcare costs Managing and reducing healthcare costs Flexible plan design Flexible plan design Greater financial control Greater financial control Simplifying health plan mandates- Federal vs. State. Simplifying health plan mandates- Federal vs. State. Simplify administration for multi-state employees Simplify administration for multi-state employees

What are the Advantages of Self Funding? Cash flow advantages. Cash flow advantages. Monies held by employer earn interest. Monies held by employer earn interest. Eliminate most state taxes. Eliminate most state taxes. Administrative fees are less than traditional fees. Administrative fees are less than traditional fees. Overhead and Profit eliminated. Overhead and Profit eliminated. Comprehensive Reporting Comprehensive Reporting Employer knows where every penny goes Employer knows where every penny goes

How is your plan protected? Stop Loss policies provided by A+ carriers limits your risk. Stop Loss policies provided by A+ carriers limits your risk. Specific policy for individuals Specific policy for individuals Aggregate policy for the group Aggregate policy for the group Plan protected by ERISA Plan protected by ERISA Plan complies with Federal laws NOT State laws and mandates Plan complies with Federal laws NOT State laws and mandates

Large Claim Cost Sharing

What Benefits Can be Included in Self Funded Plans? Medical Medical HMO look alike plan designs called EPOs. HMO look alike plan designs called EPOs. PPO plans using networks such as Great West Network, CCN/First Health, Blue Cross PPO network PPO plans using networks such as Great West Network, CCN/First Health, Blue Cross PPO network Dental Dental Traditional or PPO plans Traditional or PPO plans Vision Vision You may use any provider (optometry or ophthalmology) You may use any provider (optometry or ophthalmology) Eye glasses and contacts included Eye glasses and contacts included Wellness Programs Wellness Programs

What is the first step? Select an experienced benefit broker Select an experienced benefit broker Gather your data Gather your data Census (sex, age, dependent status, and zip code) Census (sex, age, dependent status, and zip code) Current plan design Current plan design Current premiums Current premiums Compare fully insured vs. self funded Compare fully insured vs. self funded

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