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47% of groups 200-1000 employees are partially self-funded
- Groups of 25 or more employees are increasingly discovering self-funding
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Gain control of vendors and admin costs
- Implement cost containment features
- Receive monthly claims reports
- Eliminate state premium tax of 2.65%
- Eliminate certain state mandated benefits
- Eliminate some insurance company margins
- Improve cash flow
- Create your own benefit plan design
- 65% COBRA subsidy retained by employer
- COBRA rates – charge fully insured amount
- Opportunity to introduce meaningful prevention & wellness program and acupuncture / chiropractic coverage
Employers are facing double digit increases in 2009 due to the down economy and they are asking, "Is there anything else?"
There is an alternative. Employers need to investigate the cost-reducing solution of partial self-funding. This option is suitable for group benefit plans versus traditional fully-insured group plans.
The plan’s core component is a very high deductible plan purchased by the Employer to cover the employees and dependents in case of a catastrophic illness or accident. With the resulting substantial reduction of premiums, the employer now pays for the in-patient and outpatient services including hospital, surgery, office visits, laboratory tests, x-rays, prescription drugs and other outpatient care of employees and their dependents. Employer's costs are based on actual health care costs incurred, rather than just paying their current increasing plan premiums. If the expenses exceeds the high deductible, the insurance carrier covers the remaining expenses to a limit of $ 5 million.
The plan is an Employer designed, partially self-funded ERISA health plan. Like traditional self-funding, this ERISA Health Plan is exempt from state mandated benefits, state regulations, and premium taxes that add unnecessary costs to the Employer’s Health Plan. Silicon Valley Health Plans also includes health plan budget certainty for both specific and aggregate claims. While traditional self-funding plans for larger Employers require claims history for underwriting and quoting, our plans do not.
Silicon Valley Health Plans are designed to have the Employer work directly with the highest quality broker, TPA (Administrator), Case Management Company, Wellness Management Company, Provider Organization (PPO) and Pharmacy Benefit Manager (PBM). Each of these professional service organizations provide the Employer Health Plan with the type of quality and technologically-advanced services needed. |
