Partially Self-Funded Plans

Employers with group sizes of 35 or more employees can take advantage of reduced premium by utilizing a well known approach to their employee benefit plan.  Partial Self-Funding offers greater control over benefit expenditures by allowing the employer to assume a small degree of risk, thus reducing premiums and resulting in lower monthly costs.  By taking on some of the risk that the insurance company would have had to assume, employers start realizing savings by not paying full cost on employees who do not use their health insurance.  If the employer were to take a consensus of employees in the age range of 18-25, they would find that 95% of these employees had never used the company provided health insurance.  Why pay a high monthly premiums to an insurance company that is not providing a benefit???  

The following list is some of the services Employee Benefit Concepts, Inc. provide under a Partially Self-Funded approach:

• Strategic Planning
• Benefit Plan Design
• Funding Analysis
• Vendor Management
• Compliance
• COBRA Administration
• HIPAA Administration
• Claims Management
• Financial Reporting
• National PPO Integration
• 5500 Informational Reporting

Employers determine the specific level or risk that the company will assume for each covered employee and dependent.  Under a Partially Self-Funded program, Employee Benefit Concepts, Inc. pays the claims on behalf of the employer up to the elected maximum annual amount for each covered person.  This limit is known as the Specific stop-loss.  Specific stop-loss protects the employer from catastrophic exposure for each enrolled individual.  When the employer has met the Specific stop-loss maximum for an individual, the stop-loss carrier pays all eligible expenses thereafter for the remainder of the benefit period.

Benefits of Self-Funding:

• Immediate cash flow due to the lower monthly premiums.
• Employer controls the money that would be otherwise held for claims reserves by the insurance company.
• Elimination of premium tax.  Insurance companies have to pay tax on premium collected.  Insurance companies just pass that tax on to the employer in the form of higher premiums.
• Stop-Loss protection to cover catastrophic expenses.
• Variety of "incurred and paid" options to limit risk.
• Employers design there own benefit structure.
• Regulated by Federal Laws (ERISA), not State Laws. 
• Claim reserves are kept to a minimum, until they are needed.

To find out how you can benefit from Employee Benefit Concepts, Inc. Partially Self-Funding Plans, call us at (248) 855-8040 or (800) 344-4101.