self funding group health plans presented by brenda fagan johnson
TRANSCRIPT
Self Funding Self Funding Group Health PlansGroup Health Plans
Presented by Brenda Fagan Johnson Presented by Brenda Fagan Johnson
What is Self Funding?What is Self Funding?
Alternative to conventional group Alternative to conventional group health insurance.health insurance.
Employer pays claims instead of Employer pays claims instead of premium.premium.
Stop loss provides coverage for Stop loss provides coverage for catastrophic losses.catastrophic losses.
Who Should Consider Who Should Consider Self Funding?Self Funding?
Employers with 50 or more who Employers with 50 or more who are interested in:are interested in: Managing and reducing healthcare Managing and reducing healthcare
costscosts Flexible plan designFlexible plan design Greater financial controlGreater financial control Simplifying health plan mandates- Simplifying health plan mandates-
Federal vs. State.Federal vs. State. Simplify administration for multi-Simplify administration for multi-
state employeesstate employees
What are the Advantages of What are the Advantages of Self Funding?Self Funding?
Cash flow advantages. Cash flow advantages. Monies held by employer earn Monies held by employer earn
interest.interest. Eliminate most state taxes.Eliminate most state taxes. Administrative fees are less than Administrative fees are less than
traditional fees.traditional fees. Overhead and Profit eliminated.Overhead and Profit eliminated. Comprehensive ReportingComprehensive Reporting
Employer knows where every penny goes Employer knows where every penny goes
How is your plan protected?How is your plan protected?
Stop Loss policies provided by Stop Loss policies provided by A+ carriers limits your risk.A+ carriers limits your risk. Specific policy for individualsSpecific policy for individuals Aggregate policy for the groupAggregate policy for the group
Plan protected by ERISAPlan protected by ERISA Plan complies with Federal laws Plan complies with Federal laws
NOT State laws and mandatesNOT State laws and mandates
Large Claim Cost SharingLarge Claim Cost Sharing
0
20
40
60
80
100
120
140
160
100 kClaim
60kclaim
200kclaim
40kclaim
EmployeeEmployerStop Loss Carrier
What Benefits Can be What Benefits Can be Included in Self Funded Included in Self Funded
Plans?Plans? MedicalMedical
HMO look alike plan designs called EPOs.HMO look alike plan designs called EPOs. PPO plans using networks such as Great PPO plans using networks such as Great
West Network, CCN/First Health, Blue West Network, CCN/First Health, Blue Cross PPO networkCross PPO network
DentalDental Traditional or PPO plansTraditional or PPO plans
VisionVision You may use any provider (optometry or You may use any provider (optometry or
ophthalmology)ophthalmology) Eye glasses and contacts includedEye glasses and contacts included
Wellness ProgramsWellness Programs
What is the first step?What is the first step?
Select an experienced benefit Select an experienced benefit brokerbroker
Gather your dataGather your data Census (sex, age, dependent Census (sex, age, dependent
status, and zip code) status, and zip code) Current plan designCurrent plan design Current premiumsCurrent premiums
Compare fully insured vs. self Compare fully insured vs. self fundedfunded