Pros and Cons of Reference Based Pricing for Self-insured

As self-insured employers look for ways to control healthcare costs, they have to evaluate every strategy that might help them accomplish that goal. Reference based pricing is a pricing strategy that eliminates rate negotiation between employers and healthcare providers, and may result in employers spending less on their employees’ medical claims. Continue Reading >

Reference based pricing allows employers to better predict medical budgets. A medical plan administrator working on billing while eating an apple.

Aggregate vs Specific Stop Loss Insurance

While stop-loss coverage has become an increasingly popular tool for self-insured employers, it’s still a topic of confusion for many people. The purpose of stop-loss coverage is to provide a layer of financial protection for employers. Two primary types of stop-loss policies exist, aggregate and specific, and employers typically use both types to give themselves maximum financial protection. Continue Reading >

A stop-loss provision as part of an employee health insurance plan helps control employer healthcare costs. Employee’s child receiving medical care during the holidays.

7 Questions to Ask When Comparing Stop-Loss Carriers

Self-funded health insurance is the right choice for many midsize and even small employers. Self-funding may allow your business to save on healthcare costs and customize your coverage to better suit your employees’ specific needs. This kind of plan can be financially risky; instead of paying set premiums to an insurance carrier, a self-insured employer is responsible for all of its employees’ claims. Those are unpredictable costs.  Continue Reading >

Self-funded insurance can be financially risky, but stop-loss coverage limits your liability. Puzzle pieces with insurance fits into risk space.

How COVID is Impacting Claims for the Self-Insured Employer

Though the worst of the COVID crisis is over, it may be several more years before American employers realize its full impact on employee health claims. The pandemic created conditions that kept some people from accessing necessary medical and mental health care. Soon, both those patients and their employers may pay the price. While some self-insured employers saw their claims drop at the height of the crisis, COVID may still have a wave of high-cost claims in store. Continue Reading >

There were a lot of reasons why people put off preventative medical treatment during the early days of the pandemic. This cardiologist has a red stethoscope over her shoulders.

What to Consider When Moving from Fully Insured to Self Funded Insurance

Making the move from fully insured to self funded health insurance may allow a business to save money, enjoy greater flexibility and assume more control over its health care plan. When the transition is smooth, employees may hardly realize a shift is happening. But for the business leaders working behind the scenes, moving from fully insured to self funded can take months of careful planning and strategizing.  Continue Reading >

When the transition from fully insured to self funded health insurance is smooth, employees may hardly realize a shift is happening. But for the business leaders like this woman working behind the scenes on behalf of her staff behind her, the move can take careful planning and strategizing.

Why Workplace Wellness Programs Fail—and What to do Instead

When workplace wellness programs work, it’s a true win-win. Employees get access to the resources that help them take care of their physical and mental health, allowing them to do their most productive work and live their best lives. Employers, in turn, benefit from having a healthy workforce—especially self-insured employers, who only pay for their employees’ real medical claims. The healthier its employees are, the less the employer pays in health costs and absenteeism. Continue Reading >

Direct Contacted Medical Services for Self-Funded Employers

When a Walmart employee needs an organ transplant or spinal surgery, they don’t go to their local hospital. If they’re enrolled in the company’s benefits program, all Walmart associates can go to the Mayo Clinic for certain surgeries—with Walmart footing the bill. The company has a contract with the Mayo Clinic to provide services to its employees, and has similar contracts with other health systems throughout the country.  Continue Reading >

Child having his throat looked at by a masked doctor. There are a few ways that smaller businesses can cut costs by using direct contracted medical services.

Can Self-funded Employers Offer Plans That Will Appeal to Potential Employees?

Without its employees, your business is nothing but an idea. If you have a team of highly-qualified, deeply-engaged people working for you, you’ll generally go a lot further than you would with a team of middling performers. The best employees also tend to be the people who have the most job options. Someone who has an incredible resume, glowing references and a long list of skills and certifications may be able to be picky about where they work. Not only do you want those employees coming to work for you, but you also don’t want them going to work for your competitors. To get them on your team, you’re going to have to offer competitive health benefits. Employers considering going the self-funded route often wonder if they will be able to offer appealing healthcare benefits. Continue Reading >

A young professional sits on a desk smiling and working on a laptop. Send-funded plans can be designed to appeal to prospective employees.


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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.