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 >

Preventive Medicine is the Best Medicine

It’s preferable to stop a fire from starting than it is to stop the flames from spreading, or to undo the damage that they cause. Prevention is naturally a primary goal for healthcare providers, who strive to keep patients from becoming sick and/or getting sicker. But self-insured employers benefit from this branch of  healthcare too. Though it’s hard to say definitely if preventive medicine will help you dramatically slash costs, embracing prevention has lasting benefits for all involved. Continue Reading >

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 >

What Employers with Self-Funded Plans Should Know About High-Value Claims

In a largely unpredictable world, some things are constants. Housing prices and college tuition will rise every year. So will healthcare costs. Each year, more and more Americans incur high-value medical claims in excess of $500,000. For self-insured employers to accurately plan ahead, it’s important to have some idea just how much and how quickly those major claims will rise. Stop Loss Insurance, Inc. has been tracking self-funding trends for our clients for many years. Back in 2014, we broke down data from Highmark, Inc. on high-value claims to help our clients understand the current landscape. Six years later, the numbers have changed but the trends remain the same. Here’s what you need to know. Continue Reading >

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 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 >

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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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