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Silicon Valley Health Plans

Why Partial Self-Funding?

Fully Insured Plan

pie chart - fully insured plan

Partially Self-Funded Plan

pie chart - partially insured plan
   
  • 47% of groups with 200-1000 employees are partially self-funded
  • Groups of 50 or more employees are increasingly discovering self-funding
  • 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
  • COBRA rates – charge fully insured amount
  • Opportunity to introduce meaningful prevention & wellness program and acupuncture / chiropractic coverage

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 the employees and their dependents. Employer's costs are discounted using the PPO network providers. If the expenses exceeds the high deductible for any member, the insurance carrier covers the remaining expenses to an unlimited amount.

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's Health Plan with the quality and technologically-advanced services needed to lower cost.

 

 

 

 

 

 

 

 

 

 

 

 

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