self-funding for businesses
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Self FundingHealth Benefits for Businesses
Are you a Good Candidate?
Are you a Good Candidate?
High employee participation (75%)
Are you a Good Candidate?
High employee participation (75%)
An employer that takes a long-term view of its medical plans
Are you a Good Candidate?
High employee participation (75%)
An employer that takes a long-term view of its medical plans
Financially stable organization
Are you a Good Candidate?
High employee participation (75%)
An employer that takes a long-term view of its medical plans
Financially stable organization
Healthier workforce
Advantages...
Advantages...
1. Lower Fixed Costs
Advantages...
1. Lower Fixed Costs
Manage variable claim costs=less than premium charged
Advantages...
1. Lower Fixed Costs
Manage variable claim costs=less than premium charged
Robust risk management=greater savings
Advantages...
2. Greater Flexibility and Control of costs
Advantages...
2. Greater Flexibility and Control of costs
No modified community rate
Advantages...
2. Greater Flexibility and Control of costs
No modified community rate
Premiums based on singular risk profiles/mod factor
Advantages...
3. Better Access to Claims Data
Advantages...
3. Better Access to Claims Data
Develop targeted risk management programs
Advantages...
3. Better Access to Claims Data
Develop targeted risk management programs
Meet specific needs of employees
Advantages...
4. Elimination of Most Premium Taxes
Advantages...
4. Elimination of Most Premium Taxes
Most plans do not pay state premium taxes
Advantages...
4. Elimination of Most Premium Taxes
Most plans do not pay state premium taxes
Save more money
Save More Money...
Save More Money...
1. Comprehensive Programs
Save More Money...
1. Comprehensive Programs
Deliver Multiple Benefits
Save More Money...
1. Comprehensive Programs
Deliver Multiple Benefits
Prevention and Wellness services
Save More Money...
2. Sustainable Strategies for Managing Healthcare Costs
Save More Money...
2. Sustainable Strategies for Managing Healthcare Costs
Provide the incentives to ensure high levels of participation in wellness programs
Save More Money...
2. Sustainable Strategies for Managing Healthcare Costs
Provide the incentives to ensure high levels of participation in wellness programs
Focus on identifying preventable risks and improve compliance with chronic conditions
Save More Money...
2. Sustainable Strategies for Managing Healthcare Costs
Provide the incentives to ensure high levels of participation in wellness programs
Focus on identifying preventable risks and improve compliance with chronic conditions
Employ data to determine cost drivers and the highest levels of risk
Save More Money...
2. Sustainable Strategies for Managing Healthcare Costs
Provide the incentives to ensure high levels of participation in wellness programs
Focus on identifying preventable risks and improve compliance with chronic conditions
Employ data to determine cost drivers and the highest levels of risk
Gauge the year-to-year financial impact of focused wellness programs
Other Lifestyle Modification
Programs...
Other Lifestyle Modification
Programs...
Smoking cessation
Other Lifestyle Modification
Programs...
Smoking cessation
Pre-diabetes Education
Other Lifestyle Modification
Programs...
Smoking cessation
Pre-diabetes Education
Exercise programs
Other Lifestyle Modification
Programs...
Smoking cessation
Pre-diabetes Education
Exercise programs
Weight management
Other Lifestyle Modification
Programs...
Smoking cessation
Pre-diabetes Education
Exercise programs
Weight management
Stress management
Stop-Loss Insurance...
Stop-Loss Insurance...
Specific Stop-Loss Insurance
Stop-Loss Insurance...
Specific Stop-Loss Insurance
Specific Deductible
Stop-Loss Insurance...
Specific Stop-Loss Insurance
Specific Deductible
Reimburse employer for cost over SSL claim amount
Stop-Loss Insurance...
Specific Stop-Loss Insurance
Specific Deductible
Reimburse employer for cost over SSL claim amount
Protects employer against catastrophic claims from individuals
Reduce Your Risk
1. Cover organ transplants separately
Reduce Your Risk
1. Cover organ transplants separatelyHaving this policy separate can protect you from unexpected costs.
Reduce Your Risk
2. Address specialty pharmaceuticals
1. Cover organ transplants separatelyHaving this policy separate can protect you from unexpected costs.
Reduce Your Risk
2. Address specialty pharmaceuticals300 drugs considered specialty-this plan will reduce cost by obtaining discounts
1. Cover organ transplants separatelyHaving this policy separate can protect you from unexpected costs.
Reduce Your Risk
3. Manage dialysis treatment Carefully
Reduce Your Risk
3. Manage dialysis treatment CarefullyContract with dialysis management specialists to control costs
Reduce Your Risk
4. Encourage employees to manage chronic conditions
3. Manage dialysis treatment CarefullyContract with dialysis management specialists to control costs
Reduce Your Risk
4. Encourage employees to manage chronic conditionsPatients who follow doctors instructions are more likely to reduce billing costs
3. Manage dialysis treatment CarefullyContract with dialysis management specialists to control costs
Reduce Your Risk
Making the Transition...
What should you look at to ensure an easy transition from a fully insured plan to a self-funded arrangement.
Making the Transition...
Employee Demographic
What should you look at to ensure an easy transition from a fully insured plan to a self-funded arrangement.
Making the Transition...
Employee DemographicDetermine the best type and level of a self-funded plan that suites your companies needs.
What should you look at to ensure an easy transition from a fully insured plan to a self-funded arrangement.
Making the Transition...
Premium Outflow and Claims ExperienceDo a comparison of premiums versus claim costs to assess your fully insured rates
Making the Transition...
Risk AppetiteThe Stop-Loss insurance will cover what your claims can't absorb
Premium Outflow and Claims ExperienceDo a comparison of premiums versus claim costs to assess your fully insured rates
Making the Transition...
Plan Design and Admin. Options
Making the Transition...
Plan Design and Admin. Options
Making the Transition...
Plan Design and Admin. OptionsWork with our Brokers to satisfy the needs of both employer and employee.
Making the Transition...
Plan Design and Admin. OptionsWork with our Brokers to satisfy the needs of both employer and employee.
We want ensure quality experience with the appropriate mix of premiums, deductibles and out-of-pocket expenses.
Making the Transition...
Medical Management Service Costs
Making the Transition...
Medical Management Service CostsDetermine what vendors and how many vendors is appropriate for your company
Making the Transition...
I
Information gathered from AmWINS Group Benefits: Self-Funding Guide
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