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 >

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 >

You Paid What?: Improving Transparency About Health Care Costs

The human's natural instincts for curiosity are not always about being nosy: other considerations, such as financial transparency, help to distinguish what is right and fair within the healthcare industry. Going into an operation with some sort of estimated rate for services and goods keeps patients from being exploited and overcharged. In this case, being nosy can benefit Americans greatly with their health costs. Continue Reading >

Keeping Millennials on Your Self-Insured Health Plan: Why It Matters and How to Do It

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 >

Personalized Medicine: The Future Has Arrived

What if a simple blood test could predict your future? It’s a very real possibility, thanks to personalized medicine, also called precision medicine. Under this model, each patient’s medical care is completely customized and tailored to his or her DNA makeup. Personalized medicine can’t predict a person’s medical future with 100% accuracy, but it can help doctors identify potential roadblocks in their patients’ futures and develop treatments to target those roadblocks. Continue Reading >

How Employee Engagement Can Reduce Healthcare Costs

Americans don’t agree on much, but everyone acknowledges that healthcare costs are just too high. Ballooning insurance costs translate to financial strain, which trickles down to employees in the form of budget cuts and staffing changes. That’s why it makes so much sense to include employees in discussions about rising healthcare costs. That might represent a radical change from the status quo in some companies, but it’s a change worth making. Employee engagement looks different in each company, and it’s up to the employer to find the blend of programs and initiatives that’s most beneficial – both for employee health and satisfaction, and for the bottom line. Continue Reading >

A New Era: Association 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 >

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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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