Self-Insured Health Plans

Financial risks are a big factor in whether to self-insure or not. There is little argument about costs; self-insured or partial self-insured plans are less expensive and allow you to customize plans more easily while also being less heavily regulated.

Controlling healthcare costs under a self-insured health insurance plan is much more effective for most employer groups. It is not for every employer since it is determined by utilization activities on medical claims history and current risk.

Important and effective points to consider when deciding on a self-insured plan:

  • Although all insurance carriers can perform Administrative Services Only, ASO, we believe that it is worth the effort to look at Independent Third Party Administrators, TPA for an extensive review.
  • Besides a large enough Provider Network it is also advisable to directly contract with local providers and/or distant providers for high performance results.
  • Improve Data Analytics to better understand the nature of utilization claims.
  • Install a Prescription Benefit Management strategy that is clearly effective. More of your claims go to prescriptions than physician and hospital services so much attention is needed here.
  • A Medical Claims Review program also will guard against over inflated or miscoded claims.
  • A Wellness Program is usually difficult to establish a specific ROI but many studies indicate that it does improve the long term health of your members which translates to probable savings.
  • When possible, establish an On-site or Near-site medical clinic to lower costs.

These actionable objectives will help lower claims cost as well as contain Stop-Loss premiums.


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