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Controlling Health Care Costs With Self-Funded Plan Options

OnDemand Webinar (105 minutes)

Understand the advantages and potential concerns that come with self-funding and whether it's the right decision for your organization.Healthcare costs are constantly on the rise, and the cost to employers and employees is only becoming more of a burden. Traditional insurance carriers often offset these increasing costs by raising copays and deductibles, and employers paying the premiums find themselves having to shift the increased costs to their employees. Through self-funding, however, employers can tailor the benefits offered to their employee populations, which can prove more cost-effective for both employers and employees. Self-funding involves a more hands-on approach by involving buy-in from employers and employees alike to fully realize its advantages. As a small trade-off for the cost-savings and ability to customize benefits to an employer's workforce, employers and their TPAs must address certain plan design and compliance considerations. This material will provide a framework for the self-funding industry by describing the various concerns of which employers must be aware with an eye toward maximizing benefits while minimizing costs.


Nicholas Bonds, The Phia Group, LLC Kelly E. Dempsey, The Phia Group, LLC


Overview of Self-Funded Plans

• Governing Law (e.g., ERISA, ACA, HIPAA, FMLA, COBRA, Mhpaea)

• Benefits of ERISA Preemption

• Important of Strong Language in the Spd

• Compliance Concerns

• Benefits of Self-Funding vs. Fully Insured

• Risks of Self-Funding vs. Fully Insured

Employer/Employee Cost Sharing in Self-Funded Plans

• ACA Changed the Landscape

• What Employee Is Paying vs. What Employer Is Paying

Stop-Loss Insurance, Reinsurance and Other Options

• Stop-Loss Is a Specific Type of Reinsurance

• Stop-Loss Regulated by State Law

• Deductibles, Aggregate vs. Specific

• Level Funding

• Captives

• Duration of a Policy Has a Lot of Options/Implications

Designing Your Plan

• Compliance Considerations

• The Relevant Players

• Choosing and Administrator

Cost Control Measures for a Self-Funded Plan

• Overall Considerations

• Employer Incentives

• Plan Incentives

• Carve Outs (e.g., Dialysis, Specialty Drugs)

• Medical Tourism

Case Examples

• The Phia Group Health Plan