Category Archives: Considering Self Funding

Why Would An Employer Choose Self-Funded Insurance?

When it comes to health insurance, choice is a good thing. American employers are spoiled for choice these days, with a variety of insurance arrangements available to even small businesses. But all that choice necessitates making some tough decisions. Before you can get into the nitty-gritty about benefits and co-pays, first you have to make a big decision. Should your company be fully insured and pay premiums to an insurance company, or should you choose self-funded insurance, sidestepping the insurer and paying employees’ claims yourself? Continue Reading >

self-funded

Setting the Record Straight on Self Funding: Forget These Five Myths

How much do you know about self-funding? For many people, the answer is probably “nothing,” but self-funding should be a familiar concept to anyone involved in their company’s decision-making process around health benefits. Unfortunately, this insurance arrangement isn’t well understood by everyone—and that misunderstanding keeps companies from saving money. Continue Reading >

self-funding myths

COVID-19’s Impact on Self-Insured Employers

Every American business has been touched by the COVID-19 pandemic. If you’re feeling anxious and uncertain about how this unprecedented experience will affect your business’s healthcare spending, you’re in good company. This is an issue that all self-insured employers are grappling with right now. While there’s still plenty that none of us know about the road ahead, we do already know so much more than we did just last month about how COVID-19 will affect self-insured employers. Continue Reading >

covid-19 self-insured employers

COVID-19 Q&A for Self-Funded Employers

While none of us could have exactly predicted the COVID-19 pandemic, the stop-loss industry is nothing if not prepared for emergencies. We know that a lot of self-funded employers are scrambling right now to figure out what happens next. Stop-loss carriers have mobilized to increase flexibility that allows policyholders to maintain coverage, and to make sure that policyholders have all the resources they need to weather this storm. Here are answers to some of the most common questions we’re hearing right now. Continue Reading >

COVID-19

Is a Stop Loss Captive Right for You?

As employers increasingly seek out methods to control costs without sacrificing benefits, stop loss coverage has emerged as a useful tool. It protects the self-funded employer from having to pay out-of-pocket for employees’ catastrophic claims. One of the ways to secure stop loss coverage is via a stop loss captive. Continue Reading >

Stop loss captive

For Healthcare Data Security, 2018 Was a Bad Year

Did your organization’s healthcare data security protections hold during 2018? Most employees have no idea how to answer that question. Unless they work in IT or handle financial transactions, data security might not be a top priority – or at least, it might not seem like a top priority. One breach is all it takes to realize how wrong that thinking is. Any company that handles healthcare information is obligated to safeguard it, even if the company’s only healthcare records are related to employee insurance. Hospitals and other health-care providers aren’t the only entities that are affected by accidental and malicious breaches.  Continue Reading >

Doctor at computer

Where’s Our Check? Getting Stop Loss Claims Paid Quickly

With stop loss coverage, claims costs depend on the services you need, as well as the actual costs of those services. This can be tricky to navigate, and reimbursement for claims can also be a pain to receive in a timely manner. But, what you may not know is that there's actually a lot on the back-end that goes into claim reimbursement. Continue Reading >

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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.