Molyneaux Insurance
  • The Molyneaux Way
    • Trumps and Tricks Euchre Event
    • ClearPath™
    • Our Team
    • Privacy Policy
  • Business
    • Employee Benefits >
      • Education and Compliance
      • Share to Compare
    • Risk Management
    • Claims Management
  • Industries
    • Franchises and Associations
  • Personal
  • Contact Us
  • Careers
    • Open Positions
  • Blog
  • The Molyneaux Way
    • Trumps and Tricks Euchre Event
    • ClearPath™
    • Our Team
    • Privacy Policy
  • Business
    • Employee Benefits >
      • Education and Compliance
      • Share to Compare
    • Risk Management
    • Claims Management
  • Industries
    • Franchises and Associations
  • Personal
  • Contact Us
  • Careers
    • Open Positions
  • Blog

​Molyneaux ​Blog

The benefits of self-funding

10/16/2019

 
Picture
There are typically two approaches to securing health coverage for your staff - group health insurance or self-funding.

Self-funding, however, can be costly and risky for some employers and is usually only done by larger organizations with thousands of employees. However, there is a hybrid model that can help small and mid-sized employers provide their staff with affordable health coverage: partial self-insuring.
​
To understand how partial self-insuring works, we should start with the basics of what a self-insured plan is. In a fully self-insured plan, the employer bears the risk of all costs incurred under the plan for claims and administration.

In essence, the employer acts as the insurer and pays claims from a fund that it pays into along with employees, who pay their share of premiums into the fund.

Also, the employer will usually contract with a third-party administrator or an insurance company to process claims and provide access to a network of physicians and other health care providers.

How partial self-insuring works

Partially self-insured arrangements provide some of the benefits of being self-funded but without all the risks, while plans will have the same benefits as insured plans have. Here's how they work:
  • Employers and their employees still pay premiums, a portion of which goes into an account that will be tapped to pay the first portion of claims that are filed. That means that the employer is acting as the insurer for those claims.
  • The other portion of the premium is paid to an insurance company, which is sometimes known as a stop-loss policy.
  • Plans have an aggregate deductible for all claims filed by employees, meaning that once that deductible is reached, an insurer starts paying the claims instead.
  • Premiums are calculated to fund the claims to the aggregate deductible amount. In other words, the employer and employees are paying for the worst-case scenario in each policy year.
  • The employer may get a refund at the end of the policy year if the total claims come in at a level that is less than expected. The employer can either be reimbursed for this amount or use those funds for the next policy year.

Lower risk than fully self-insured plan

Typically, an employer should have at least 25 workers if it is considering a partial self-funded arrangement, but we've seen plans with fewer enrollees.

Many employers will opt for a partially self-insured plan to save money, but these types of plans also allow an employer to design a more useful and valuable plan for its workers.

The key to making this work is cost control, without which claims can spiral and drive up premiums at renewal.

Knowing exactly how much to set aside for reserves and how much you should set your employees' premiums, deductibles, and other cost-sharing can be complicated. But with the right mixture of benefits, plan design, and education, you can control behavior, which drives claims, in order to keep renewal rates from increasing too much each year.

The fine print

Employers considering partial self-insuring as an option should keep in mind the following:
​
  • There is additional responsibility, as the employer basically becomes an insurer of sorts.
  • There is additional paperwork for these plans since the employer also becomes a payer.
  • There are compliance issues that the employer needs to consider (ERISA and the Affordable Care Act, for example).
  • There is some additional risk to the employer, as it is paying claims.
  • If you have too many claims, you could face a non-renewal by your stop-loss insurer. If you are cancelled, it may be difficult to seamlessly enter the insured market.
 

Comments are closed.

    Categories

    All
    COVID 19
    Cyber Security
    Directors And Officers
    Employee Benefits
    News
    Personal Insurance
    Property And Casualty
    Risk Management
    Trumps & Tricks
    Wellness
    Workers Compensation

    Archives

    March 2021
    February 2021
    January 2021
    December 2020
    November 2020
    October 2020
    September 2020
    August 2020
    July 2020
    June 2020
    May 2020
    April 2020
    March 2020
    February 2020
    January 2020
    December 2019
    November 2019
    October 2019
    September 2019
    August 2019
    July 2019
    June 2019
    May 2019
    April 2019
    March 2019
    February 2019
    January 2019
    December 2018
    November 2018
    October 2018
    September 2018
    August 2018
    July 2018
    June 2018
    November 2017
    September 2017

Company

About Us
Our Team
​Trumps & Tricks
Testimonials
Careers
​News
Privacy Policy

Services

​Commercial Insurance
Risk Management
Employee Benefits
Group Health Insurance

Retirement Benefits
​Personal Insurance

Industry Specialization

Contact Molyneaux

​​5025 Utica Ridge Road
Suite 100
Davenport, IA 52807
​101 East Main Street
​
Suite 202
Galesburg, IL 61401
Phone: 563-324-1011 
Toll Free: 800-713-6930

Partner Agencies

LMC Insurance & Risk Management Logo
Independent Insurance Services Logo
Molyneaux Logo
The Friedman Group Logo
© COPYRIGHT 2021 Molyneaux Insurance