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

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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