Whether you are fully insured and thinking about going self funded, or currently self-funded and wondering whether you should become fully-insured, there is no simple answer. The right choice depends entirely upon the specifics of your business. The good news is you are more likely to make the right choice if you really understand your choices and that is where advantage benefits group comes in. We are here to educate and inform you on the best choices available for your organization when deciding between a self-funded health care plan or a fully insured health care plan.
fully insured plans
In traditional fully insured health plans, the organization pays a premium rate that is fixed for a year. The organization pays a monthly premium based on the demographics, location and type of work done by the group. The health care claims are paid by the insurer through the collected premiums. The covered employees are then responsible to pay any deductible amounts and co-payments as required under the policy.
self-funded plans
Similar to an insurance premium, a self-funded plan has fixed components like administration fees, stop-loss premium, and network access fees. These fixed components are billed monthly based on plan enrollment just like an insurance premium. The organization sponsoring the self-funded plan also pays the claims costs incurred by the insured employees, and this cost varies from month to month based on the health care use by the insured employees. Stop-loss insurance reimbursements are made if the claims costs exceed the catastrophic claims levels in the policy. This means the total cost of a self-funded plan is the fixed costs plus the claims expenses less any stop-loss reimbursements, which in many cases can be less than fully insured plans.
creative stop-loss solutions
If your organization has chosen to sponsor a self-funded health insurance plan, stop-loss insurance can help guard against the risks of this choice. Stop-loss insurance pays your employees’ medical claims after you have paid a certain predetermined amount. Some policies are designed to protect you against high claims by any one employee or family member while other policies protect you against an unexpectedly large amount in total claims.
There are many things to consider when choosing stop-loss insurance like risk exposure, premium costs, etc. Further, not all insurers offer this specialized product and policies often vary widely. Advantage benefits group will help you decided which, if any, policies are right for you by meeting both your needs and your budget.
customized reporting
At advantage benefits group, we provide customized, concise reporting for all of our self-funded clients. Our custom reports can be tailored to fit your organizations needs, which results in reliable and relevant reports every time.