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 >

Health Apps: They’re Everywhere, And They Could Help Self-Funded Employers Control Healthcare Spending

When was the last time you scrolled through the health and fitness apps available on your favorite device? Maybe you’ll check them all out the next time you have, oh, five or six free days in a row. That’s probably about how long it would take you to review the full range of health apps available in your device’s app store. Continue Reading >

Tips for Businesses with Self-Funded Insurance to Improve Overall Healthcare Spending

Saving money is the primary reason that many employers decide to provide self-funded insurance. Balancing that objective and the healthcare needs of employees can be an ongoing struggle. Trimming benefits would help you cut spending, but not without sacrificing employee health and morale. Instead, think about making some strategic shifts to your plan. For some employers, it only takes a few small changes to dramatically slash healthcare spending. Continue Reading >

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 >

ERISA: How it Protects Self Funded Plans

Did you know self-funded plans are required to comply with ERISA guidelines? Typically when we think of ERISA we think of pensions and retirement benefits. However, even though the plan pays for healthcare coverage, a self-funded plan is fundamentally a pool of money. And that money needs to be insured. In order to protect the members, ERISA covers the plan and its fiduciaries. Continue Reading >

Here’s What’s Happening with Proposed Policy and Prescription Drug Costs

When 79 percent of Americans agree about something, politicians take notice. That’s the percentage of people who consider drug prices “unreasonable,” according to a 2019 KFF poll. Outrage about rising prescription drugs costs has reached a fever pitch. However, these feelings are nothing new. Early in his presidency,  the Trump administration vowed to make medication more affordable for American patients. They unveiled a new policy with the claim to reduce drug costs. So have they delivered? 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

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

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

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

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

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

Reference: “2013 Employer Health Benefits Survey”. The Henry J. Kaiser Family Foundation.

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

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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).

Reference: “Self-Insured Health Plans: State Variation and Recent Trends by Firm Size”. Employee Benefit Research Institute, Nov 2012, Vol. 33, No. 11.

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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.

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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.

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

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