Request a call Login

  • The news channels are flooded with updates on the trials and tribulations of the Affordable Care Act’s website and accompanying registration process. Politics aside, the implementation of this piece of legislation could mean big changes and larger financial challenges for your health benefits plan.

    Most small business owners today are able to provide some form of health insurance coverage for their employees through large commercial healthcare plans. However, with the Affordable Care Act, these plans will come at a cost for business owners. In fact, Ohio businesses are expected to see a 71% increase in these premiums. 

    These high increases may force you to reduce or eliminate the health benefits you are able to extend to your employees, forcing them to buy insurance from the government’s healthcare marketplace.

    An Alternative to Government Healthcare

    The appeal that the Affordable Care Act has for many Americans is also one of its biggest challenges for those looking to enroll. Long wait times, sparse customer service and other registration obstacles will make it difficult, not to mention aggravating, for your employees to secure health benefits which match their needs.  

    Fortunately, you have another option for your company’s health benefits. You can implement a self-insured plan. Self-insured companies are responsible for their own medical costs, eliminating the need to subsidize the healthcare expenses of other insurance groups.  

    How Self-Insured Policies Work

    Self-insured healthcare provides plan flexibility, control and the potential for premium reductions for your business. Companies are responsible for contributing to a claims fund each month and that money is used to cover all employee medical expenses beyond their out-of-pocket costs. With a self-insured plan, you can still provide quality care to your employees and protect them from having to navigate through miles of government red tape.

    An essential component for any self-insured policy is known as the TPA, or third-party administrator. TPAs ensure that your employees are getting all the benefits promised to them in their insurance policy.  

    Who Has the Time?

    Of course, if you’re a small-to-medium sized company, you are probably thinking “Sounds great, but we don’t have the time or resources to manage self-insured policies ourselves.” 

    That’s where GMS comes in. Our services:

    • Let you focus on growing your business. We cover everything from eligibility to claims management and even customer service.
    • We’ll worry about the policy details. You worry about growing your business.
    • Save you money. We underwrite a custom policy for your group so you won’t pay for extra insurance that you don’t really need.
    • Limit your risk. We offer stop-loss insurance, which minimizes your exposure in the event of an unforeseen and major health claim.

    Learn more on how a self-insured plan administered by GMS can drastically reduce your health care costs, increase the cash flow of your business and ultimately provide better coverage for your employees and their dependents. Contact us today. 

    Image credit: 

    Creative Commons Image: Images_of_Money

     

  • With the waters of healthcare becoming murkier every day, employers and employees abdicate many of the cost-auditing responsibilities regarding their healthcare to their insurance company. Unfortunately, placing this level of trust in your company’s health insurance carrier leaves the proverbial fox to mind the hen house.

    Those who purchase health coverage through a commercial provider mistakenly believe their insurance company is actively advocating for them and monitoring the costs incurred for healthcare services. While this is far from the case, the shocking part of this reality is that the insurance companies are forcing you to pay more than you should for your company’s coverage.  

    Benefits of Self-Insured Plans

    A self-insured health plan can reduce healthcare premiums for your small business by reducing overhead and other management costs charged by big insurance plans. When you have a third-party administrator like Group Management Services manage your self-insured plan, you ensure your employees receive everything promised to them in their plan and limit you from spending more money than anticipated. 

    Negotiate prices: Insurance companies are billed by the hospital based on what the hospital thinks they should charge for their services. On the other hand, TPAs look at what the hospitals pay Medicare – which is often considerably less than what the hospital would bill to an insurance company – and negotiate healthcare costs from there. This can have significant impact on healthcare costs (in your favor). To learn more about this business model, I encourage you to read this article from the New York Times about the “$1,000 toothbrush.” 

    Eliminate Price Secrecy: The practice of provider and hospital consolidation in the marketplace creates an uneven playing field for insurance companies to negotiate true cost-savings for their members. A TPA like GMS will underwrite a custom policy for your group so you don’t pay for coverage that the group doesn’t need and monitors all claims to reduce your financial risk. 

    Audit bills: TPAs have the resources and knowledge to help your employee check each bill to ensure there is no double billing for equipment or health care services. A TPA can challenge prices for services that are beyond “reasonable and customary,” substantially reducing patient bills and keeping your claims down.

    Employee peace-of-mind: With the changing landscape of healthcare, you can assure your employees have job security along with quality and affordable health coverage. A TPA’s main concern is you and your employees, ensuring a more personable and attentive service experience. 

    Increased cash flow: Self-insured plans managed through a TPA brings the control of processing of health claims back in-house, minimizing losses and reducing administrative costs. 

    Self-insured plans through a third-party administrator like GMS can give you more control of your coverage and help cut costs, while still providing quality coverage to your employees. Interested in how a self-insured plan could help your business? Get a quote now or speak with one of GMS’ TPA experts. 

  • How healthy are your employees? If you are a small business owner looking to save money on your healthcare, let’s hope they are all vegetarian non-smokers training for a marathon, right? 

    While that would be great, for your small business what matters more for your bottom line is the type of healthcare plan you provide. You have two choices: a fully insured plan or a self-insured plan. 

    TPAs and self-insurd plans can save your small business money. Image is a piggy bank with a $100 bill. “Health Care Cost” by Tax Credits licensed by CC BY 2.0

    Type of health insurance coverage matters

    Many small business owners today provide some form of health coverage through fully insured healthcare plans. However, with the Affordable Care Act, the prices on those premiums are on the rise. 

    In the face of these increases, you might want to consider a self-funded group plan, which can:

    1. Increase cash flow
    2. Limit your risk
    3. Keep employees happy

    How it works: With a self-insured policy from GMS you pay a specific amount into a claims fund each month. This contribution is what covers your employees under your plan. With a self-insured plan from GMS you only pay for what you need, and you can further protect yourself with stop-loss insurance so you won’t have unexpected expenses in the event of a major claim. 

    “When companies are self-insured, they assume most of the financial risk of providing health benefits to employees. Instead of paying premiums to insurers, they pay claims filed by employees and health care providers. To avoid huge losses, they often sign up for a special kind of “stop loss” insurance that protects them against very large or unexpected claims, say $50,000 or $100,000 a person.”

    Step 2: Third Party Administration

    Further earn your trust
    With our TPA services, we hold ourselves accountable for the policies we underwrite for your group. You will know that your employees are getting all the healthcare benefits promised.

    Lower your premiums
    Proper management of healthcare can lead to lower claims, lower claims leads to lower premiums which will make your cash flow higher.

    Centralize points of contact
    You no longer have to hire and pay a separate TPA. Now, you can work directly with GMS for all of your healthcare benefit needs.

    What is the benefit of having a third-party administrator manage my plan?

    When you have a third-party administrator, like Group Management Services, manage your self-insured plan you ensure your employees receive everything promised to them, and limit you from spending more money than anticipated. Plus, you have the choice to pick coverage that your group actually needs.

    More Related Links:

    Learn more about TPAs and self-funded plans by reading our previous posts below:

     

    What do you think about the health insurance plan options for small businesses? Would you make any changes or suggestions? Let us know your thoughts in the comments below.

  • When it comes to finding the right health plan for your business, the key is to find an option that makes sense for your business. One route that a business can go is to invest in TPA services for a self-funded health plan, which offers several benefits that can help owners save money and mitigate their risk with proper planning and support. Self-funded insurance also allows businesses to avoid some of the increased regulations on healthcare, which is a big reason why more small and midsize employers are choosing to self-insure, according to the Society for Human Resource Management.

    With all that in mind, self-funding sounds like an intriguing option, right? However, there are a pair of misconceptions about self-funding that either dwell in the past or are not that relevant to business owners. Here are two reasons why owners avoid self-funding, and how a TPA can dispel those arguments.

    Image of a business owner considering self-funded health insurance through TPA services.

    Myth No. 1: Self-Funding Will Sink Small Businesses

    Some business owners remember stories about a company sinking because they went self-funded. What essentially would happen is that a business with self-funded insurance would run into a large number of costly claims after one or several employees got really sick. Because they were self-funded, the business would theoretically be stuck paying all of those claims without any help from a provider, which would force them to shut down since they wouldn’t have the cash flow to actually run their business and pay their other bills.

    While businesses back in the ‘70s and ‘80s did run into this problem, times have changed. Businesses can now invest in something called stop-loss insurance to manage their risk and set a maximum liability number for their yearly claims. 

    Stop-loss insurance allows a business to mitigate its liability so that it can self-fund its insurance without having to fear a year with an unexpected number of claims. Let’s just say that your business is given a $10,000 monthly maximum through stop-loss insurance. At the end of the year, that’s $120,000 max. If your business exceeds $120,000 in claims in a year, you’re reimbursed the overage by the reinsurer.

    This policy also works in your favor if you have fewer claims than expected. If you don’t reach your maximum claims liability number, you simply get to keep the difference, or you can take advantage of a “premium holiday.” This allows you to use the refund to pay for one or several insurance premiums in advance. Since the refund could affect your tax filings, this option can help you avoid having to do a tax adjustment on your healthcare fees since we’ll just deduct your refund from the premiums for the following year.

    Myth No. 2: Self-Funding Makes Owners Deal with Several Moving Parts

    As we’ve mentioned before about self-funding, “normal businesses with fewer than 5,000 employees won’t have the infrastructure to comply with all the regulations and make it financially feasible.” Managing a self-funded plan can mean carefully overseeing several important moving parts. This means that you’re going to need some help because self-funding can be a lot of work for whomever oversees their HR.

    While some owners may be scared off by self-funding, there’s a simple solution to these moving parts: a TPA. What we can do as a PEO with TPA services is manage everything in house so that you can benefit from self-funding without having to deal with all the regulations and administration needs, which can include: 

    • Electronically sending out a file on health plan eligibility every day
    • Having an in-house programmer who can receive necessary data files
    • Access to a pharmacy benefits manager, who works with pharmacies on plan eligibility and drug costs

    Those are just a few of 30 moving pieces that are necessary for self-funding. When you work with a TPA, we can be as transparent about this process as you’d like so that you can see how everything works, or you can let us take care of the work while you focus on other important matters. Regardless of how much or how little you want to know about the process, a TPA enables you to take the HR work out of your hands. This way they can sign up for self-funding, pay their premiums, and know that the work is being done for them.

    Using TPA Services to Self-Fund Your Business

    The key to a good self-funded plan is a TPA that can take care of all the moving parts for your business. As a Professional Employer Organization that offers TPA services, Group Management Services can allow you to enjoy the benefits of self-funding while managing your plan. Contact GMS today to talk one of our experts to learn more about self-funding and to get a quote for your business.

  • Escalating costs of healthcare and benefits have led business owners across the country to seek out a solution that makes the most sense for their company. Of the many options out there, self-funded health insurance has become a realistic opportunity for many small businesses thanks to third-party administrators.

    These organizations, also known as TPAs, allow business owners to take advantage of self-funding, which can provide a “greater level of flexibility that comes with being able to tailor the plan to their needs,” according to the Society for Human Resource Management. The self-funding process can be complicated, but a good TPA can simplify the process so that employers can reap the benefits of self-funded insurance without having to deal with the risks of managing it themselves.

    Image of a third-party administrator for a small business.

    How Does the TPA Process Work?

    While some people refer to TPAs as “claims payers,” the role a TPA plays is much more intricate than that. Let’s start by imagining that your business is going from a fully-insured carrier to become self-funded. In this instance, the business owner is  now the plan fiduciary, which just means that they are financially responsible for the plan.

    Since you’re now self-funded, there’s no insurance company anymore, and you rent what is called a PPO network. For example, GMS primarily works with Cigna. These networks have a long list of providers and hospitals in their network and negotiate discounts with each of these groups. You then pay your network a set cost per employee, per month so that they have access to these discounts.

    This is where the “claims payer” name comes into play. When members of your plan go out and generate insurance claims, those claims go directly to your TPA. The TPA then administers these claims to tell providers who’s eligible on the plan, processes them, and bills the client for monthly fees and the amount of money that needs to be paid to these providers.

    Do I Need a TPA if I want Self-Funded Insurance?

    Absolutely. While a Google-sized company can afford to have an in-house TPA, normal businesses with fewer than 5,000 employees won’t have the infrastructure to comply with all the regulations and make it financially feasible. A TPA gives you access to a team of people who can handle the day-in, day-out needs of self-funding, which can range from daily electronic filings of plan eligibility to a pharmacy benefits manager who deals with every prescription one of your members has filled.

    There are also the potential financial ramifications of managing self-funded insurance in-house. The right TPA can offer you stop loss insurance to mitigate your liability. As GMS’ Costas Reamensnyder points out, a self-funded health insurance plan allows you to “pay only for actual claims; not the total expected claim level from a fully insured carrier.” This means your plan can save a substantial amount of money each year. . A TPA can help you set a cap for maximum liability, which means that you can properly budget for your plan and cover yourself from unforeseeable circumstances.  This maximum liability is provided by adding a stop loss insurance policy. It essentially mitigates your financial liability by limiting the plan’s maximum exposure.

    The PEO TPA Connection

    If interested in self-funding your health insurance, GMS can help. As a Professional Employer Organization, we can help business owners in a variety of ways, including our TPA services. Contact GMS today to talk to one of our experts about self-funded health insurance for your business.