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Why Self-Funded Health Insurance is Right for Your Business

by Costas ReamensnyderNovember 4, 2016 8:00 AM

Considering all of the recent healthcare regulations, now is a better time than ever to consider a self-funded health plan. Self-funding your health insurance is a long-term strategy to save money, gain total control over your plan, and may offer immediate savings.  

It is a common misconception that self-funded health plans are only advantageous for large employers. In a traditional self-funded arrangement, small employers weren’t able to absorb the risk on becoming self-insured due to potential losses. By self-insuring your plan coupled with a stop loss policy (also known as a catastrophic policy), you mitigate your financial risk while allowing your plan to reap all of the benefits. Stop loss policies allow employers to evaluate potential savings and maximum exposure by becoming self-funded. Prior to stop loss insurance, the potential savings were estimated and max exposure was an unknown.

Group Management Services offers stop loss insurance that allows small employers to be rated on their own medical applications while experiencing savings due to our economies of scale. This means we’re able to offer lower stop loss premiums due to our volume, but your premiums aren’t affected by other plans should they not do as well as yours.

Image of a business owner who switched to a self-funded health insurance plan.

Various Benefits of Self-Funding

  • Transparency. Self-insuring allows employers to view all costs paid by the plan.  These costs include fees for administration, broker, network access, and actual claims data. This knowledge allows employers to accurately evaluate their costs, and identify the areas they can potentially save more money.
  • Tax. Self-insured plans are not subject to premium taxes. 
  • Use of capital. Rather than paying your monthly premium to a fully insured carrier, self-funding allows you to hold a good portion of this capital. Let’s say your plan has an annual premium of $250k with your fully insured carrier. By switching over to a self-funded plan, your total annual premium costs have now decreased to $60k with a max claim liability of $180k. This means you are now only paying $5k monthly in premium (instead of $20k with your current carrier), and funding claims up to a max total of $180k throughout the year. Since your max out of pocket by being self-funded is only $240k (premium plus claim liability), you’re already guaranteed to save $10k. The $180k in claim liability stays in your bank account, allowing employers to utilize this capital until needed to fund claims.
  • Pay only for actual claims; not the total expected claim level from a fully insured carrier. On a fully insured plan, you know you’re paying the total monthly premium regardless of claim experience. If your self-funded plan runs extremely well throughout the plan year, any amount left over in your claim liability is additional savings to the plan. If your plan only experiences $120k in claims, the $60k left over in the claim fund is additional savings for your plan. Does your fully insured carrier offer you a refund at the end of a good plan year? If they do, are they keeping a percentage of your savings?
  • Limit the surprises. Fully insured plans don’t typically notify the employer of high claims until the renewal period. By that point, you can anticipate a heavy increase due to claim experience. Self-insured plans allow for employers to be notified of plan expenses on a weekly basis throughout the year. This is extremely valuable for plans to know if an early renewal is beneficial and other options to assist the employer and the members.
  • Let us share the risk. By offering stop loss insurance on your plans, GMS has every incentive to properly monitor your claim volume and accuracy. We are responsible for reimbursing your plan for all claims paid over your maximum liability. Therefore, we work closely with employers and their members to keep costs in line. 
  • Tailor the plan design. Self-funding allows employers to decide what plan options are most advantageous for your members without having to pay for unnecessary add-ons.


Enjoy the Benefits of Self-Funding

Self-insuring your health plan provides a copious amount of advantages, allows you to effectively evaluate costs, and offers substantial savings. The figures used in the example provided are from an actual proposal to one of our clients. Don’t take my word for it; the numbers speak for themselves. Give us a call today at 330-659-0100 or contact us online to talk to one of our experts about a self-funded quote today!

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