Self-Funded health benefit plans provide small to medium size business a convenient and safe way to provide more affordable health care benefits to their employees and families, so they can enjoy the benefits of self-funding without taking on the added risk. These plans are governed by federal law and must provide minimum essential coverage under the Affordable Care Act. Self-Funded plans are underwritten.
Stop-Loss insurance protects the employer's assets from higher-than-expected claims. The employer is issued stop-loss insurance that reimburses the employer for expenses that exceed a pre determined levels. These are also called Aggregate limits applied to the whole group. Specific limits apply to each covered individual.
Self funded Programs offer customizable plan designs to make it the right fit for each employer
The Employer's costs are the following:
Employer pays a monthly billing statement, similar to those accustomed with traditional Insurance. The monthly bill has three components
- Stop-loss premium. This is the amount covers insurance to reimburse the employer for any covered expenses over the aggregate and specific deductibles.
- Administrative costs- this is the charge for administrative services such as customer service, claims administration, case management, access to provider networks and others.
- Monthly claim account funding-employers make monthly payments to provide for their groups' anticipated claims for the year. These funds are considered general assets of the employer.