Self-Funded Medical How Can Self-Funded Medical Insurance

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Self-Funded Medical

• How Can Self-Funded Medical Insurance Work for
  You?

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Self-Funded Medical

• Can mean savings through greater Control,
  Flexibility, and Reporting

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Self-Funded Medical

• Consider your preferencesDo you want
• Greater control of your plan design?
• More insight into how health care dollars are
  spent?
• Flexibility to adjust your benefits as needs
  change?
• If you answered, Yes!

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Self-Funded Medical

• If you answered, Yes!
• Then Self funding may be a good fit because
• It can provide tax savings
• You pay only for claims incurred
• Robust reporting tells you where your medical
  dollars are being spent
• You have full protection through Stop-Loss
  Insurance
• It is easy to administer because you pay a
  monthly bill, just like Fully-Insured plans

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Self-Funded Medical
Self-Funded premium dollars are broken down into
3 different costs
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Self-Funded Medical

• Administrative Costs
• Preferred Provider Network access fees
• Billing, claim statements, booklets, ID cards,
  and commission
• Prescription Benefit Management
• Compliance, Legal, Chronic Disease Management,
  and Wellness Program
• Reporting

Administrative
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Self-Funded Medical

• Reinsurance Costs
• Stop-Loss InsuranceLimits Risk
• Specific Stop-Loss Insurance caps your risk per
  individual insured
• Aggregate Stop-Loss caps your risk per month and
  per year

Reinsurance
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Self-Funded Medical

• Claims Funding
• Claims are funded up to a predetermined amount.
  Your reinsurance pays claims that are above the
  predetermined amount
• Run-Out Protection for claims that are incurred
  but not yet paid upon termination of plan
• If actual expenses are less, you keep the surplus

Claims Funding
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Self-Funded Medical

• A flexible portfolio of plans allows you to
  design a plan that fits your companys needs
• Choice of preventive care options
• Choice of deductibles
• Choice of coinsurance
• Choice of out-of-pocket
• Choice of prescription benefits
• Plans provide personalized service for you and
  your employees

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Self-Funded Medical

• Plan features that help to reduce the claims
• Preferred Provider Network billing agreements
  reduce the claim amounts
• Chronic Disease Management assistance helps
  prevent unnecessary claims
• Prescription Benefit Management reduces Rx claims
• Wellness programs and Preventive Benefits help
  keep your employees and their families out of the
  doctors office
• Insurance company Claims Administration prevents
  bogus claims

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Self-Funded Medical

• The Next Step
• A proposal for Self-Funded Medical will provide
  more detail and answer questions.