Imagine you’re the CEO of a company with 49 employees. You’re currently covered through a fully insured health plan, but are considering switching to a self-insured group plan due to the potential premium increases resulting from the Affordable Care Act.
All of the companies you know with self-funded plans are larger companies (250+employees), so you aren’t sure if this is the right solution for you. You’re also concerned that since you would pay self-insurance claims directly, your company could be liable for a major claim if an employee has a serious health issue.
What do you think - what would you do in this situation? Before you make a decision, consider the following key points.
What happens when you have a major claim on a self-insured policy?
The answer depends on the stop-loss insurance coverage.
How Stop-Loss Protects you From Major Unforeseen Claims
- Stop-loss insurance protects you from higher-than expected claim totals. If your group’s claim amount exceeds the self-funded limit, the stop-loss insurance provider will pays the difference.
How Third Party Administrators (TPAs) Can Help
- Reduce administrative tasks - TPAs administer the health plan by processing the claims, issuing ID cards, and dealing with customer questions
- Offer stop-loss with self-funded plans
Benefits of TPA Self-Funded Health Plans with GMS
Creative, custom-tailored solutions for your employees
- Only pay for what you need - pay a specific amount into a claims fund each month
- Stop-loss insurance included - you won’t have unexpected expenses in the event of a major claim
- One bill - streamline billing makes payments easy