self-funded plans

It's The Great Health Insurance Renewal, Charlie Brown!

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It’s you and your health insurance broker.  You’re thinking, this year I’m really going to get tough with this insurance company and I’m gonna ‘em them who’s boss.  I’m gonna be a tough negotiator and this is the year I’m gonna to get a better deal for my employees.  Seriously, you might as well be Charlie Brown saying to himself, “This year I’m really gonna kick that football” and like every other time, Lucy swipes the football away from you at the last second—just like she always does.  There you are, lying flat on your back wondering what just happened.

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Don’t be that guy this year, when your BUCA (Blue Cross, United, Cigna, Aetna) plan sends you this year’s increase—you need to fight back. When you hear your broker tell you that healthcare costs “just go up”, or when they bring you this year’s gimmicky product that’s supposed to make everything better—you need to fight back. Find that broker who is more like Snoopy, the Flying Ace, shooting fake reasons for increasing costs out of the sky. You can find one at www.healthrosetta.org. Or just call me. I’ll fight for you.

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Your employees are counting on you to look for a plan that provides transparency and lowers costs.  They’re hoping you’re going to come up with a plan that reduces out-of-pocket and gives them better access to high-quality healthcare.  I know what you’re thinking, “Better care, lower out-of-pocket? But I’m already paying more than I can afford.  Better care is going to cost even more!”  All I can tell you is that you’re wrong.  You’re not listening to the right advice.  Stop being a blockhead!

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Let me give you an example of what happened at one of my clients this week.  We uncovered that an employee is taking a high cost brand name drug.  After some research, we determined that the brand name is just a quirky dosage of the generic ingredient.  The drug was costing the employer $733.00 per month.  I know that’s not much, but when we found out a local, independent compounding pharmacy could make the same dosage of the generic that the brand had for only $75.00 per month, we rejoiced like we’d won the lottery!  Transparent Advisor = 1, Big Bad PBM = 0.  And that was only one prescription! Imagine what we’ll find when we analyze every drug in their claims report.

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Don’t let your employees be the one kid who looks in their treat bag and all they have is a rock.  That’s no good for anyone. Be the employer everyone wants to work for because your health plan is the best around. It IS possible! You CAN do it! And it’s NOT scary! #letsfixhealthcare

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Need help designing the best health plan in town? You can count on us. Message us at cristy@custombenefits.work. We can help.

Intro to Self-Funding | North Carolina Benefit Advisors

The topic of Self-Funding is huge, so let's break it down into smaller bites to digest.  Check out this great video on it!

Benefits Easy: Intro to Self-Funding | North Carolina Employee Benefits

As the first month of 2018 wraps up, companies have already begun the arduous task of submitting budgets and finding ways to cut costs for the new year. One of the most effective ways to combat increasing health care costs for companies is to move to a Self-Funded insurance plan. By paying for claims out-of-pocket instead of paying a premium to an insurance carrier, companies can save around 20% in administration costs and state taxes. That's quite a cost savings!

The topic of Self-Funding is huge and so we want to break it down into smaller bites for you to digest. This month we want to tackle a basic introduction to Self-Funding and in the coming months, we will cover the benefits, risks, and the stop-loss associated with this type of plan.

THE BASICS

·       When the employer assumes the financial risk for providing health care benefits to its employees, this is called Self-Funding.

·       Self-Funded plans allow the employer to tailor the benefits plan design to best suit their employees. Employers can look at the demographics of their workforce and decide which benefits would be most utilized as well as cut benefits that are forecasted to be underutilized.

·       While previously most used by large companies, small and mid-sized companies, even with as few as 25 employees, are seeing cost benefits to moving to Self-Funded insurance plans.

·       Companies pay no state premium taxes on self-funded expenditures. This savings is around 1.5% - 3/5% depending on in which state the company operates.

·       Since employers are paying for claims, they have access to claims data. While keeping within HIPAA privacy guidelines, the employer can identify and reach out to employees with certain at-risk conditions (diabetes, heart disease, stroke) and offer assistance with combating these health concerns. This also allows greater population-wide health intervention like weight loss programs and smoking cessation assistance.

·       Companies typically hire third-party administrators (TPA) to help design and administer the insurance plans. This allows greater control of the plan benefits and claims payments for the company.

As you can see, Self-Funding has many facets. It's important to gather as much information as you can and weigh the benefits and risks of moving from a Fully-Funded plan for your company to a Self-Funded one. Doing your research and making the move to a Self-Funded plan could help you gain greater control over your healthcare costs and allow you to design an original plan that best fits your employees.

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