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SELF-FUNDING HEALTH BENEFITS

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Page 1: SELF-FUNDING HEALTH BENEFITS. Two ways to illustrate Self-Funding A.Follow the money – Fully Insured – Self-Funded B.The Extra “0” Plan – What is an HRA

SELF-FUNDING HEALTH BENEFITS

Page 2: SELF-FUNDING HEALTH BENEFITS. Two ways to illustrate Self-Funding A.Follow the money – Fully Insured – Self-Funded B.The Extra “0” Plan – What is an HRA

Two ways to illustrate Self-Funding

• A. Follow the money– Fully Insured– Self-Funded

• B. The Extra “0” Plan– What is an HRA

Page 3: SELF-FUNDING HEALTH BENEFITS. Two ways to illustrate Self-Funding A.Follow the money – Fully Insured – Self-Funded B.The Extra “0” Plan – What is an HRA

Why it works

A. An illustration comparing Fully Insured to Self-Funding

B. Industry-wide stats on health and utilizationC. Grid comparing Fully Insured to Self-FundingD. Who is a good candidate?E. Case Study

Page 4: SELF-FUNDING HEALTH BENEFITS. Two ways to illustrate Self-Funding A.Follow the money – Fully Insured – Self-Funded B.The Extra “0” Plan – What is an HRA

Stop Loss

A. What it is

B. Contract Types

Page 5: SELF-FUNDING HEALTH BENEFITS. Two ways to illustrate Self-Funding A.Follow the money – Fully Insured – Self-Funded B.The Extra “0” Plan – What is an HRA

Two ways to implement Self-Funding

A. Baby Stops

B. The Big Bang (for your buck)

Page 6: SELF-FUNDING HEALTH BENEFITS. Two ways to illustrate Self-Funding A.Follow the money – Fully Insured – Self-Funded B.The Extra “0” Plan – What is an HRA

Evaluating & Purchasing Stop Loss Insurance

• Terminal Liability Option (TLO)• Monthly Aggregate Accommodation• Specific Advance Funding• Rate Caps• Aggregating Specific• Options for Groups Under 100 ee’s

Page 7: SELF-FUNDING HEALTH BENEFITS. Two ways to illustrate Self-Funding A.Follow the money – Fully Insured – Self-Funded B.The Extra “0” Plan – What is an HRA

Myths & Misperceptions

A. Busy, Busy Bee

B. Lasers – the boogeyman in the closet

C. The monster under your bed – looming large claimant

D. Run-Out – the Grasshopper & The Ant

Page 8: SELF-FUNDING HEALTH BENEFITS. Two ways to illustrate Self-Funding A.Follow the money – Fully Insured – Self-Funded B.The Extra “0” Plan – What is an HRA

E. Maximum Liability – chicken little syndrome

F. No Guaranteed Renewal – too many fish in the sea

G. The Ugly Step-Sister – ugly renewals

Page 9: SELF-FUNDING HEALTH BENEFITS. Two ways to illustrate Self-Funding A.Follow the money – Fully Insured – Self-Funded B.The Extra “0” Plan – What is an HRA

How Self-Funding works with a TPA

A. The key elementsB. Pharmacy BenefitsC. PPOsD. Maximum cost containment is more than a

PPO discountE. Minimizing Future RisksF. Administrative Services Only (Carrier) vs. TPA

Grid

Page 10: SELF-FUNDING HEALTH BENEFITS. Two ways to illustrate Self-Funding A.Follow the money – Fully Insured – Self-Funded B.The Extra “0” Plan – What is an HRA

Questions & Answers


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