Category Archives: Considering Self Funding

A New Bill Could Raise the Stakes for Self-Funded Insurers

Self-funded insurers may be negatively affected in a newly drafted bill titled “Protecting Patients from Surprise Medical Bills Act” back in September. Though its goal is to minimize unexpected medical bills and prevent medical bankruptcies, self-funded insurers and covered employees, might not garner any savings from this proposed legislation. Continue Reading >

Keeping Millennials on Your Self-Insured Health Plan

If some news outlets are to be believed, Millennials only care about avocado toast and Netflix. But while this generation isn’t well respected by some older Americans, Millennials take health insurance seriously. Considering that they have lived through a period when health insurance has been a hotly contested issue, it shouldn’t be a surprise that Millennials are invested in their coverage. Continue Reading >

Chronic Kidney Disease: A Major Hurdle for Self-Insured Employers

Many Americans worry that they or their loved ones will suffer from cancer, stroke, heart disease or dementia. Kidney disease isn’t as high-profile a condition, and the average person probably doesn’t give it much thought. Self-insured employers don’t have that luxury. Chronic kidney disease is common, deadly and hugely expensive to treat. Continue Reading >

Association Health Plans (Small Business Health Plans)

For small businesses that have struggled under the Affordable Care Act, a new proposal has been introduced that would expand health insurance options afforded to small employers. The new proposal, known as the Association Health Plans, would help small businesses unable to afford employee health coverage to join together and increase their bargaining power. This proposal is expected to see the addition of self-funded plan options in the coming years, but the effects are currently unclear. Continue Reading >

How HRAs, FSAs and HSAs are Administered in Self-Funded Plans

At a time when many people feel powerless over their own health care, giving your employees choices about how they manage their own medical costs is a good thing — both for them and for you. With Health Savings Accounts (HSAs), Health Reimbursement Arrangements (HRAs), and Flexible Spending Accounts (FSAs), self-funded plans are possible for employees to utilize. Continue Reading >

Pros and Cons of Pooled Stop Loss Insurance

Pooled stop-loss insurance has its pros and cons, depending on your business structure and employee needs. It's essential to take the time to carefully weigh these pros and cons of pooled stop-loss insurance before committing to a policy. Obtaining coverage with a large group of fellow sponsors can garner your company with additional benefits, but also less overall control of the process. Continue Reading >

How Self-Insured Plans Can Avoid the High Cost of Gaps in Coverage

Stop-loss insurance is not health insurance, but rather a type of financial reinsurance. Unlike health insurance, stop-loss ensures protection from debt when payable claims exceed a deductible. Stop-loss and health benefit plans have seen an increase in disputes regarding what is payable, how much is payable, and what can be covered by stop-loss. This has in turn led to higher amounts of claims paid by benefit plan sponsors that are not covered by stop-loss insurance. 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.