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 >
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 >
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 >
Do you know the most common type of cancer in the U.S.? Judging by awareness ads, personal experiences and the GoFundMe pages you see shared on social media, you might assume that breast or lung cancers are the biggest threat. Skin cancer, you might assume, falls somewhere down the list. You see plenty of pink ribbons for breast cancer awareness and billboards about the dangers of smoking, but have you seen many mentions of skin cancer lately? This May, hopefully you will. Continue Reading >
If only a crystal ball or portal to another time could help us predict the future of American health care. Heck, even a Magic 8 ball with a high rate of accuracy could be useful. Alas, no such magic device exists (we think), so the confusion and uncertainty that surround health care and insurance aren’t ending anytime soon. Many people agree that our current system is broken, but no simple solution exists to bring down costs and give all Americans access to the care they need. Considering the political discord around this issue, it seems unlikely that a major change – like a move to a single-payer system – is just around the corner. So what does that have to do with self funded insurance? Continue Reading >
Amazon now offers original movies and TV shows, grocery delivery, two-day shipping – and stop-loss insurance? It’s a possibility, now that the company is turning its attention to healthcare and health insurance technology. Continue Reading >
Did your organization’s healthcare data security protections hold during 2018? Most employees have no idea how to answer that question. Unless they work in IT or handle financial transactions, data security might not be a top priority – or at least, it might not seem like a top priority. One breach is all it takes to realize how wrong that thinking is. Any company that handles healthcare information is obligated to safeguard it, even if the company’s only healthcare records are related to employee insurance. Hospitals and other health-care providers aren’t the only entities that are affected by accidental and malicious breaches. Continue Reading >
The lack of transparency around medical pricing puts self-insured employers and their employees at a disadvantage. Without the bargaining power that major insurers have, self-insured employers can’t be certain that they’re getting the best possible prices for the services that their plan members need. Enter reference based pricing. It’s a pricing strategy that more and more self-funded employers are using to control costs. Traditionally, hospitals and health care providers set inflated prices for services and insurers negotiate lower rates for their members. A procedure that a hospital charges $10,000 for may only be billed at $5,000, depending on the patient’s insurance plan. Continue Reading >
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 >
With leveraged trend, the amount covered by the stop loss carrier can increase drastically based on an upward medical trend rate. This higher amount is shared in turn with the plan members through increased premiums. Continue Reading >
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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closeFrom 2010 to 2013, the number of claims that were individually $1 million or above rose by 1,000%
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closeIn 2017 approximately 18% of the American public will purchase insurance through exchanges, radically transforming the health insurance landscape.
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closeIn 2014, 98% of large firms (= 200 Workers) offer 1+ wellness programs to their employees.
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closeThe 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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close6% 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.
closeIn 2014, PPO plans remained the most common plan type, enrolling 58% of covered workers.
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closeIn 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.
closeIn 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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closeIn 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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closeFrom 2010 – 2013, cancer followed by chronic/end stage renal disease and leukemia accounted for the top 3 costliest illnesses.
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