Self-insured health plans

Self-FundingTypically self-insured health insurance was only for large companies, 100 or more, and we never ever discussed this with our clients.  Over the past 20 years we have seen a slow progression:

  • 100% hospitalization and day surgery plans
  • $250 hospital with $125 day surgery
  • $1000 hospital and $250 day surgery
  • add co-payments for MRI-CAT-PET scans
  • two – three and now our or five tiered prescriptions co-pays
  • to deductible plans as hig as $3,000

Remember deductible plans offer one free annual physical, co-payments for doctor offices, co-payments for prescriptions and sometimes co-payments for ER, depending on the insurance company.  Everything else ( day surgery, hospital, MRI-CAT-PET scans, non routine tesing all goes to an annual plan year deductible. 

Many companies offer high deductible plans, while reimbursing a portion of the deductible for their employees through an HRA plan.  Let’s think about isn’t this a form of self-insurance. You are actually self-insuring the plan (admittedly only to $2,000 or $3,000) within a fully insured plan to back you up.   This has worked well for all of our companies!!!

The next question we have been getting is to look at higher deductibles, but we can not since the $3,000 is the highest that the state will allow through what they refer to as Minimum Credible Coverage (MCC).  The only way you can get higher deductibles is to actually self-insure. 

There are many other benefits to self-insurance that we can into at another time, but today’s blog is to let companies as low as 25 employees on the plan that they should seriously consider looking at this.

Self-insured health insurance

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