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SELF-FUNDING HEALTH BENEFITS

SELF-FUNDING HEALTH BENEFITS. Two ways to illustrate Self-Funding. A. Follow the money Fully Insured Self-Funded B. The Extra “0” Plan What is an HRA. Why it works. An illustration comparing Fully Insured to Self-Funding Industry-wide stats on health and utilization

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SELF-FUNDING HEALTH BENEFITS

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  1. SELF-FUNDING HEALTH BENEFITS

  2. Two ways to illustrate Self-Funding • A. Follow the money • Fully Insured • Self-Funded • B. The Extra “0” Plan • What is an HRA

  3. Why it works • An illustration comparing Fully Insured to Self-Funding • Industry-wide stats on health and utilization • Grid comparing Fully Insured to Self-Funding • Who is a good candidate? • Case Study

  4. Stop Loss A. What it is B. Contract Types

  5. Two ways to implement Self-Funding • Baby Stops • The Big Bang (for your buck)

  6. Evaluating & Purchasing Stop Loss Insurance • Terminal Liability Option (TLO) • Monthly Aggregate Accommodation • Specific Advance Funding • Rate Caps • Aggregating Specific • Options for Groups Under 100 ee’s

  7. Myths & Misperceptions • Busy, Busy Bee • Lasers – the boogeyman in the closet • The monster under your bed – looming large claimant • Run-Out – the Grasshopper & The Ant

  8. Maximum Liability – chicken little syndrome • No Guaranteed Renewal – too many fish in the sea • The Ugly Step-Sister – ugly renewals

  9. How Self-Funding works with a TPA • The key elements • Pharmacy Benefits • PPOs • Maximum cost containment is more than a PPO discount • Minimizing Future Risks • Administrative Services Only (Carrier) vs. TPA Grid

  10. Questions & Answers

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