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 >

What the Self Insurance Protection Act Does to Protect Self Insurance Rights

The Self Insurance Protection Act has provided protection through employer-sponsored insurance to millions of workers within the United States. As this bill continues through the legislative process to become law, self-funded employers need be following the movement of this monumental document for stop loss insurance. Continue Reading >

Opioids and the Issue of Rehab

As lawmakers work to improve the quality of healthcare and preventative solutions, the American healthcare system is left with holes that do not address the growing opioid epidemic. As opioid abuse increases, the number of self-funded employers footing the bill for drug abuse issues of employees goes up as well. Self-funded employers need to know how to protect themselves in the current political climate, should this situation arise. 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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