Self-funded Plans

Doc With Stethoscope

Health care costs continue to be the single greatest benefits expense for plan sponsors today. Self-funding solutions offer plan sponsors flexibility to custom-design a benefits program that best meets the needs of their employees, while also having the ability to take an active role in controlling health care expenses through risk management techniques. Group Benefits LLC has the experience, resources, and premier partners to help plan sponsors take control of their health care costs.

Advantages of Self-funding:
  • Cash flow benefit: Plan sponsor's cash flow is improved when money formerly held by the insurance carrier in the form of reserves for unreported and pending claims is freed for use by the plan sponsor.
  • Elimination of most premium tax: There is no premium tax on the self-insured claim expenditures. Premium tax is applied only to the stop loss premium, which is a fraction of a fully insured premium.
  • Lower administration costs: Employers find that administrative costs for a self-funded program administered through a TPA are significantly lower than those included in the premium by an insurance carrier or HMO.
  • Plan design control: Self-funding gives employers the flexibility to create and redesign their plans to best meet needs of the company and employees.
  • National provider networks: Ability to customize provider networks to meet employee needs and accommodate multi-state employers.
  • State-mandated benefits are optional: State regulations mandating costly benefits are optional because self-funding is regulated by federal legislation only.
  • Reporting: Monthly detailed reporting of costs by location, department, and type of medical service. Utilization and lag reports should also be available. Fund disbursement journals should be provided electronically.

Self-funding Analysis

Claim Analytics:

Our medical claims analytics program allows you to rapidly integrate eligibility information, medical claims, pharmacy claims, health risk assessment results, and case management data to help you:

  • Identify high-risk individuals
  • Reveal case management or disease management opportunities
  • Measure ROI of wellness and disease management activities
  • Improve plan and benefit design
  • Develop a long-term health care strategy to address the needs of the total employee population

Note: Medical Claims Analytics may not be available for all size clients.

Network Analytics:

Health care quality transparency continues to emerge as an important element in strategically managing health care cost increases. We are able to meet the changing demands of the health care selection and plan design process by providing a comprehensive software solution that allows us to analyze carrier networks using both access and quality information, allowing us to help you:

  • Make informed decisions about provider cost, quality and access
  • Compare networks on an apples-to-apples basis
  • Request the right information from health plans
  • Identify gaps in your network
  • Negotiate better health care contracts
Products and Services include:
  • Administrative Services Only (ASO)
  • Stop Loss
  • Risk Management (MGU)
  • Medical Claims Analytics
  • Disease/Care Management