Own it to Fix it
We define fixing employer healthcare as installing leading edge platforms that can lower cost while improving the member experience. A self-funded program gives you the power to do this. Because you own and control your health plan.
Control Means Optimizing
With an Advanced, Self-Funded health plan you can:
Completely replace member services with Care Coordination
Install best in class components instead of what one carrier or TPA allows
Utilize Reference Based Pricing
Receive bids from 30 insurance carriers instead of only 4-6
Change to lower price insurance while keeping the rest of your plan, (Network, administrator, pharmacy plan, etc.)
Is there insurance?
Yes, there is insurance with self-funded health plans. Even extremely large employers typically do not “self-fund” all healthcare claims. You choose liability for a pre-defined amount of member claims, the variable cost. You select a risk level with which they are comfortable. Then, you purchase insurance to cover claims in excess of that amount. The "Specific" insurance covers excess claims generated by any one person. "Aggregate" insurance covers excess claims from the entire group.
What is Self-Funding?
Instead of paying fixed rates every month, you participate in the claims performance of your group up to a pre-determined amount. Self-Funded solutions vary quite a bit. But, a key commonality is that you, the employer, can become more the architect of your own health plan. Because you will better understand and gain control over the different components of it. And then you will usually seek to optimize as many of these parts as possible. Self-Funding is not simply an alternative finance method. It is a pathway towards health plan innovation.
Self-funding is for employers who believe that healthcare costs and the plan member experience can be managed and optimized. They know that an off-the shelf health plan won’t get them there. For starters, self-funding allows you to receive claims data, so you can start managing your plan. And you will have the ability to install best in class components to address your goals.
80% of employers above 200 employees are self-funded. And there are many self-funded solutions specifically designed for employers down to 75 employees. Mid-size groups with 100-1,000 employees will find plenty of options to begin their journey into self-funding. As a firm wanting to proceed cautiously into self-funding, you can structure a program to have the type of protection that you need.