Partially Self-Funded Health Insurance

Partially Self Funded Health Care Insurance by Five Elements of Health Inc

Elements Health Plans offers clients Partially self-funded health plans options. We work with you closely to customize your plan to best meet your financial goals.

Partially self-funded plans provide a proactive approach to employees’ health benefits and an attractive and innovative alternative to traditional health insurance solutions. Partially self-funded plans utilize stop-loss protection to protect your business from unpredictable catastrophic claims. With the right kind of self-funded healthcare solution, you can:

1. Reduce Fixed Costs

All health insurance plans have administrative costs associated with the payment of claims. A partially self-funded plan saves on these administrative costs over a conventional health insurance plan.

2. Improve Reserves

There are no premium rates for partially self-funded plans.

3. Increase Plan Flexibility

With a partially self-funding health plan, you have limitless options for designing the best possible plan for your business. Co-pays, coinsurance, deductibles, covered benefits, and excluded benefits can all be tailored to meet your needs. All health plan components are sold at wholesale prices such as medical visits, labs, dental and vision.

4. Claim Utilization Data Reports

Claim utilization data reports identify claim trends specific to your group and allow you to better manage and control the costs of your benefit plan.

5. Stop Loss

Employers with self-funded health plans typically carry stop-loss insurance to reduce the risk associated with large individual claims or high claims from the entire plan. The employer self-insures up to the stop-loss attachment point, which is the dollar amount above which the stop-loss carrier will reimburse claims. Stop-loss insurance comes in two forms: individual/specific stop-loss insurance and aggregate stop-loss insurance.

6. Individual/Specific Stop-loss Insurance

Individual/specific stop-loss insurance protects a self-funded employer against large, individual health care claims. Essentially, it limits the amount that the employer must pay on a specific individual. For example, an employer with a specific stop-loss attachment point of $25,000 would be responsible for the first $25,000 in claims for each individual plan participant each year. The stop-loss carrier would pay any claims exceeding $25,000 in a calendar year for a particular participant.

7. Aggregate Stop-loss Insurance

Aggregate stop-loss insurance protects the employer against high total claims for the health care plan. For example, aggregate stop-loss insurance with an attachment point of $500,000 would begin paying for claims after the plan’s overall claims exceeded $500,000. Any amounts paid by a specific stop-loss policy for the same plan would not count towards the aggregate attachment point.