Factors to Consider for Self Funding Your Health Plan

If you are considering a self-funded health plan for your company you are certainly not alone!    Many employers, both small and large are now exploring the option of self insuring their health plan for a variety of reasons with larger long term savings topping the list.   However, self funding isn’t right for everyone; therefore we will discuss some of the factors you’ll want to consider before making any changes to your health plan. Continue Reading >

The Affordable Care Act Impact on Self-Funding Plans

The Patient Protection and Affordable Care Act (PPACA), better known as Obamacare, set to take effect January 1, 2014, will make sweeping policy changes to America’s health care and insurance industries.  The self-funding niche of the health insurance market, where employers forgo premium payments and fund their own medical costs, was on track to survive relatively unscathed by the new taxes, requirements and restrictions created by the PPACA. However, self-funding and stop-loss insurance are increasingly attracting the attention of lawmakers.  As a result of increasing regulation, the sanctuary that has been dubbed the “self-insurance loophole” is shrinking. 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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