A look at self-funded health plans

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In the wake of the COVID-19, more employers than ever are looking for ways to protect their cash flow without shifting costs to employees or trimming the benefit offered. A self-funded health plan can be a part of that solution.

Surest offers two ACA-compliant employer-sponsored health plan solutions to employers with 51+ employees—self-funded and fully insured.

Since 2016, Surest has operated its self-funded administrative services only (ASO) platform. Today, there are active members in all 50 states and Puerto Rico. Clients range from small employers to Fortune 500 companies in a number of diverse industries.

What are the benefits of a self-funded health plan?

A self-funded plan, also called a self-insured or administrative services only (ASO) plan, is what it sounds like: Employers fund their group health insurance, taking on the financial risk of—and responsibility for—providing benefits to employees. In the past, only large companies opted to self-fund. In today’s market, that’s changing. Benefits of self-funding include:

What are the risks of a self-funded health plan?

On the flip side, a self-funded plan can also be risky. The employer—not the insurance carrier—is on the hook to pay employee medical claims. If an employer doesn’t have the financial resources to absorb the costs of an employee who needs an organ transplant, for instance, or an employee who is injured in a serious car accident, those multi-million-dollar medical claims could be financially devastating to the bottom line, particularly to a smaller company. This differs from a fully insured plan, with employers paying pre-determined premiums to insurance carriers.

Protecting employers against unpredictable claims

There is risk with self-funded, but there's also stop loss insurance to protect against that risk. It's exactly as the name implies—it exists to stop losses by capping an employer’s out-of-pocket expenses for employees’ medical bills. Stop loss insurance is not medical insurance—it’s a risk management tool. If the claims exceed a predetermined amount—due to a virus outbreak, cancer diagnosis, chronic disease or devastating accident—the stop loss policy would traditionally cover those additional expenses. The tradeoff? Stop loss policies cost money, too. The two most popular types of stop loss insurance include:

Who administers claims for self-funded health plans?

Many times, businesses who choose to self-insure don't have the capacity to process their claims in-house. To alleviate the stress of trying to do it all, it’s common for self-insured employers to reach out to health plan administrators to process claims, handle customer service, and manage administrative tasks. This is where Surest comes in.

The Surest self-funded solution at a glance:

With the self-funded health plan solution, Surest has the ability to:

In addition, the Surest plan offers:

How does the Surest plan work?

Monthly paycheck deductions include everything from preventive to emergency care, primary and specialty visits, most diagnostic testing and prescription drugs, and treatment for chronic conditions, cancer and unexpected catastrophic events. That’s not all, though. The plan is innovative. It was designed to simplify the insurance experience, uncover hidden costs and address sometimes random variations in prices by using data to determine quality. Features include:

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