“We take care of the Customer ... and then some!”
It’s no secret that rising healthcare costs are out of control. Not only are consumers digging deeper into their pockets to pay for things as basic as routine care and prescription drugs, but employers nationwide, both large and small, are having to make tough decisions about the level of healthcare they can offer their employees in order to protect their bottom line.
This is why tens of thousands of employers in a vast range of industries across the country have opted to self-fund their own group health plan, allowing them to maintain greater control over their healthcare spend while also ensuring that employees have access to high-quality care.
What is self-funding and how does it work?
With a self-funded health plan (also known as a self-insured plan), the employer itself assumes the financial risk of providing health benefits to its employees. Instead of paying a pre-determined monthly premium to an insurance carrier (as with a traditional fully-insured plan), self-Insured employers pay for claims out-of-pocket as they are incurred.
Stop Loss Coverage
To protect against high-cost, catastrophic claims that could otherwise financially damage or even bankrupt a business, self-insured employers purchase stop loss coverage that will reimburse any claims that exceed a predetermined amount.
The Role of the TPA
One of the common misconceptions about self-funding is that it requires a lot of work on the part of the employer. This couldn’t be further from the truth! As a third-party administrator (TPA), our experienced team here at Unified Group Services handles all of the day-to-day claims processing and customer service inquiries for our self-funded employer groups.
The Benefits of Self-Funding
Customization and Flexibility in Coverage
Just as no two groups are exactly the same—no two health benefit plans should have to be either. Self-funded health plans can be fully-customized from top to bottom to precisely meet the unique needs and goals of every company or organization.
Cost Control and Savings
With a fully-insured health plan, the insurance carrier collects a pre-determined premium payment each month, regardless of claims volume. Once that money is paid, it’s gone for good. With a self-insured plan, the employer only pays for claims incurred by members of the health plan.
Self-insurance doesn’t mean restricted access to healthcare. In fact, self-insured plans are designed using competitive local, regional, and national networks based on an employer's needs.
Self-insured employers gain unprecedented access to detailed reporting that contains valuable data collected during the claim administration process. At Unified Group Services, our customers have access to medical and Rx data that is updated every business day—providing the in-depth insights required to make informed, actionable decisions and better manage the risks and future costs of healthcare. You simply don’t get this with a fully-insured plan.
SELF-FUNDING MYTHOnly Large Companies Can Afford Self-Funding
Self-funding can work for companies and organizations of almost any size. In fact, companies with as few as 25 employees on their benefit plan are successfully self-funding their own health insurance plans! The key is purchasing the appropriate level of coverage and stop loss protection.
Is Self-Funding Rightfor You?
At Unified Group Services, we work with every customer to create a custom health benefits plan that effectively meets the unique needs of their company or organization. If you’re new to the idea of self-funding or are uncertain if it’s right for you, we’ll help you figure that out and then work with you to determine proper levels of coverage.