Group Health Insurance (Self Insurance)
Española -- Are you a company that has contemplated being on a self insured group health insurance plan? The definition of self insurance is a risk management method in which certain defined amounts of money are set aside to pay for potential future loss due to medical claims.
This approach must be performed by a self insurance expert that uses serious risk management techniques. These plans are set in place by using actuarial and claims insurance information (claims data) by which your plan is set up. Your actuarial information should be obtained from SOA (The Society Of Actuaries). Is a self insured group health plan right for you?
You can self insure any possible insurable risk on a group health insurance plan. That risk is the amount that would be predictable or measurable enough to aggregate the estimated amount of funds necessary to pay future medical claims. What is insurable risk? This is a term that must represent any future or event that is uncertain over which the insured has zero control.
There are many other risks that can assist in making your risk self-funded or self-insurable, such as the ability to price the rate of risk in a determined plan. You can think of this as the insurable risk is one event in a large number of like risks that can be aggregated to estimate to the law of large numbers and by using probability that even can be quantified in the near future.
In most instances large catastrophic risks on group health plans are insured by a re-insurer. Those risks are not self-funded as they are highly unpredictable and can cause large losses to your group health plan. That is why you buy a reinsurer to pay for the large claim that is above your pooling charge set by your group health insurance consultant.
Re-insurance or the wholesale insurance market offers underwriting for those large claims that can put a damper on your group health plan. Any risk or potential loss that is so very large that the company or even insurance carrier couldn't pay for will be picked up by your re-insurance carrier.
Total exclusive self-insurance is not very common. Most companies are starting to move to a combination of self-insurance and full-insured health plans. In this case you purchase a high deductible health plan (HDHP) from your insurance carrier that will pay for all claims above that certain fully –insured plan deductible at 100%. Underneath that deductible you will build a layer that meets the needs of your organization.
There are a variety of ways you can design a self-insured group health plan. In some instances with very large corporations you might see that an employee benefit insurance plans are underwritten by a captive insurance company that is formed, owned, and managed by corporations in various domiciles. You might look at this option if you were a company with more than 3,000 employees insured.
The most common self-funded group health care plan you will find in the marketplace are for companies with 50-1000 employees. Smaller employers in this range help finance some of the group health insurance claims for the smaller claims of their claims. In many instances you will hire a TPA (Third Party Administrator) to help you manage the smaller claims for a small per member per month fee.
You can contract with a reinsurer to pay the really large claims, but in most cases you will use your elected fully insured health insurance carrier to get the benefit of their network discount. Check with us today to see if you qualify for our turn key self-insured group health plan for employers that range in size from 50-1000 employees.
|My Florida group health insurance broker was very helpful - he showed me all the available policies and helped lower our rates and increase our benefits.
J. Myers Miami, FL
COBRA Insurance Can Help Unemployed
en Española -- Individuals who lost their jobs in the last several months may be eligible for employer-sponsored health insurance coverage at greatly reduced rates.
The federal government will pay 65% of Cobra continuation coverage premiums as part of the American Recovery and Reinvestment Act of 2009, which was signed into law on Feb. 17. The coverage will apply to individuals who lost or lose their jobs between Sept. 1, 2008 and Dec. 31, 2009 and are eligible for continuing coverage under Cobra, a federal law called the Consolidated Omnibus Budget Reconciliation Act.
The new subsidy "makes Cobra much more affordable for a lot of people," says Scott Keyes, a senior health-care consultant at Watson Wyatt, a consulting firm. He expects participation could double or triple.
The new subsidy would last up to nine months for individuals who are not eligible for other insurance such as Medicare or a spouse's plan. It applies to employees, their spouses and any children who lost health coverage because of an involuntary termination.
Participants also can't earn more than $125,000 in the year they receive the subsidy if they are single or more than $250,000 for couples who file jointly.
Laid-off workers already can extend their job-related health coverage for up to 18 months under Cobra. The law applies to companies with 20 or more workers, which continue to offer a group health plan.
"I think this is aimed at helping people stay insured," says Amy Bergner, a principal at Mercer, a consulting firm in Washington.
She says employees who didn't elect Cobra coverage initially now have a second chance to sign up.
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