Category Archives: Affordable Care Act / Obamacare

Self -Insured Protection Act SIPA Introduced in Congress to protect Self-Funded Health Insurance Plans

In the past few years, there has been legislation introduced in several states that has called for new rules that impose limits on self-funded insurance plans and the stop loss insurance that they buy. There is a fear that these self-funded plans will appeal to companies with healthier workers and, as a result, drive up premiums for businesses that remain in typical plans. Continue Reading >

Backdoor Regulation of Self-Funding | Stop-Loss + the ACA

When the Patient Protection and Affordable Care Act (“PPACA”), (now commonly referred to as the  Affordable Care Act, the ACA, or "Obamacare") was signed into law by President Barack Obama on March 23, 2010, both the health benefits and health care industries were abuzz with rumor, conjecture, and fear.  As the dust has settled, we who service these industries have begun to appreciate the real impact the law has had on both the provision of health care, as well as payment for that care. Continue Reading >

Impact of Mental Health & Substance Use on Self-insured Plans

The issue of mental health in the United State is significant.  An estimated 26.2% of Americans ages 18 and older suffer from a diagnosable mental disorder in a given year according to the National Institute of Mental Health.  So what should employers know about compliance and the cost associated with mental and substance abuse coverage? Continue Reading >

The Affordable Care Act Impact on Self-Funding Plans

The Patient Protection and Affordable Care Act (PPACA), better known as Obamacare, set to take effect January 1, 2014, will make sweeping policy changes to America’s health care and insurance industries.  The self-funding niche of the health insurance market, where employers forgo premium payments and fund their own medical costs, was on track to survive relatively unscathed by the new taxes, requirements and restrictions created by the PPACA. However, self-funding and stop-loss insurance are increasingly attracting the attention of lawmakers.  As a result of increasing regulation, the sanctuary that has been dubbed the “self-insurance loophole” is shrinking. Continue Reading >

Attack on Self Funding

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In 2011, the top 5 most expensive medical conditions treated in US hospitals were: Septicemia, Osteoarthritis, Complication of device, implant or graft, Liveborn, and Acute myocardial infarction

From 2010 to 2013, the number of claims that were individually $1 million or above rose by 1,000%

In 2017 approximately 18% of the American public will purchase insurance through exchanges, radically transforming the health insurance landscape.

In 2014, 98% of large firms (= 200 Workers) offer 1+ wellness programs to their employees.

The most costly 1% of patients account for 20% of national health expenditures – accruing average annual expenses of nearly $90,000 per person.

6% of firms offering fully-insured plans report they intend to self-insure because of Obamacare.

In 2014, PPO plans remained the most common plan type, enrolling 58% of covered workers.

In 2012, 93% of businesses with 5,000+ employees and 80% of companies with 1,000-4,999 employees were self-funded

Massachusetts has the third-highest prevalence of self-funded insurance in the small-group market (Fewer than 50 employees).

In 2013, the average deductible was $2,906 for individuals selecting plans from marketplaces. This compares with average deductibles of $1,135 for an individual with employer coverage.

In 2013, the average annual premiums for employer-sponsored health insurance are $5,884 for single coverage and $16,351 for family coverage, up 5% and 4% respectively from 2012.

From 2010 – 2013, cancer followed by chronic/end stage renal disease and leukemia accounted for the top 3 costliest illnesses.