In The Industry

In the Industry – Article Archive

The Scoop on Self-Funding

With so many U.S. employers making the move to self-funding, it’s become a popular topic for people to explore. We collect some of the headlines here on the Self-Funding Success website as a source of more information from a variety of places and perspectives. Check out these articles to get a look at how self-funding works and the impact its having.

Survey: Self-Funded Health Plans Grow in Popularity

Dec 6, 2017|0 Comments

As organizations begin to assess options for group health coverage in 2018, new data out this week could help provide some perspective. Employer premiums on health care plans rose higher this year than they have in the past five years…. Additionally, self-funded plans…are also becoming more prevalent…[and] are becoming increasingly desirable to employers…. READ MORE

The Rise of Reference-Based Pricing

Nov 8, 2017|0 Comments

Reference-based pricing (RBP) is a fast-growing alternative to the PPO systems self-funded employers have utilized for their group benefit plans over the past 30 years…. As the PPOs started to build larger networks and attempted to bring costs down, they met resistance from key providers…. there were no regulations on what hospitals could bill for services, so the PPO shell game of “discounting” went into effect…. RBP offers two remedies to this inflated, unfair system…. READ MORE

SPBA Releases Industry Update & 2018 Forecast for TPAs & Self-Funding

Oct 17, 2017|0 Comments

In preparing for the year ahead, the Society of Professional Benefit Administrators (SPBA) has released its State of the TPA Industry & Forecast for 2018. Fred Hunt, SPBA’s active past president, has been writing this report annually for the past 37 years…. As with years past, the 2018 Forecast shares a candid perspective on current issues affecting the health benefits landscape as well as projections for the future. READ MORE

More Smaller Companies Are Self-Insuring Health Benefits

Oct 12, 2017|0 Comments

Small and midsized companies are increasingly providing their own health coverage for employees instead of buying fully insured plans …. As the Affordable Care Act drives up premiums because of more requirements and taxes, self-insurance has become a more attractive option because it is often less expensive than purchasing fully insured plans…. But some policy analysts argue the companies that are self-insuring generally have healthy employees and that leaving the fully insured risk pool results in higher costs for fully insured companies with older, less healthy employees. READ MORE

Self-funding Health Plans is Hot, But Could Get Tougher to Do

Oct 6, 2017|0 Comments

Small employers are facing formidable hurdles as they consider self-funding health insurance plans. But self-funding still holds appeal…. Increasing regulation of self-funded health plans is complicating the efforts of some employers as they seek an alternative to plans offered under the Affordable Care Act, one analyst says. Most of the stiff regulation involves stop-loss, the reinsurance that protects employers from catastrophic losses. The regulatory hurdles still are not enough to deter many employers who see self-funding as the better option… READ MORE

Views: Why Employers Should be Thinking TPA

Sep 29, 2017|0 Comments

When it comes to healthcare plan administration, ASOs (administrative services only) say they offer a big discount to self-funded plans. If you look closer, however, you’ll see that they actually do come with a cost, both monetarily and in terms of lack of flexibility…. Here are five benefits of working with a TPA… READ MORE

SPBA Member and TPA Owner Testifies Before Department of Labor’s ERISA Advisory Council

Sep 25, 2017|0 Comments

In some cases, plain words supported by facts carry the greatest impact. This was the case with the recent testimony provided by SPBA past Board of Directors member, Mary Smith, of Insurance Management Administrators, before the U.S. Department of Labor’s ERISA Advisory Council. Smith proved the point that… READ MORE

Non-Traditional Health Benefits are the Focus of New Piece in Self-Funding Series

Jun 6, 2017|0 Comments

SFS News Release: Non-Traditional Health Benefits are the Focus of New Piece in Self-Funding Series – Continuing to expand its collection of educational resources, the Self-Funding Success website has published another piece related to the benefits of self-funding. This latest resource explores the more non-traditional health benefits being implemented today and how they are saving plans money and making access to care more convenient… READ FULL RELEASE

Fiduciary Burden of the Quarter: Strictly Abiding by the Terms of the Plan Document

May 18, 2017|0 Comments

ERISA is very clear that the Plan Administrator is required to administer benefits strictly in accordance with the terms of the applicable plan document. Plan Administrators, though, are often faced with difficult situations – situations where paying a claim that might otherwise be excluded under the plan document would avoid considerable headache, appease a member of the C-suite, or more accurately reflect what the drafter of the plan document intended… READ MORE

Ready or Not, Leaders Prepare for a Value-Based Future

May 10, 2017|0 Comments

The future of the healthcare industry may be uncertain when it comes to Congressional action, or the lack thereof. But one concept that has been widely embraced for the past few years is the commitment of healthcare leaders to a value-based model for care and reimbursement. READ MORE

Cognitive Health Systems Provide Custom Analysis for Employees

Apr 28, 2017|0 Comments

With the healthcare price tag rising to $10,000 or more a year per person, employers and healthcare providers looking to lower costs and help employees manage their health are turning to big data and analytics to better handle surging costs…. cognitive health systems … integrate patient-level data from health records and other sources to create a better picture … at the individual, group and population level in order to improve patient outcomes. READ MORE

Newly Published Pieces Summarize How Self-Funded Benefit Plans Are Regulated

Apr 27, 2017|0 Comments

SFS News Release: Newly Published Pieces Summarize How Self-Funded Benefit Plans Are Regulated – Designed to be an informational tool for consumers who are exploring how self-funded health benefits work, the Self-Funding Success website has recently published two new resources… READ FULL RELEASE

Innovator’s Wellness App Aims to Improve Employee Nutrition

Apr 26, 2017|0 Comments

SFS Tech Tactics: occasional articles focused on technology’s expanding role in cost-savings and improved health in customized self-funded health plans – Jason Langheier, a physician, knew that poor diet was a major problem in the U.S. But he also knew employers could be — and should be — be part of the solution…. That’s why he created Zipongo in 2011…. the app … [is] currently in use at more than 150 companies, including Google and IBM…. and offers food benefits management services as a new employee benefit, similar to pharmacy benefit management. READ MORE

House Passes Bill to Limit State Regulators’ Powers over Self-Insurance

Apr 14, 2017|0 Comments

U.S. Congress has voted for a bill that provides protection for small and medium sized firms that choose to self-insure. The Lower House passed the Self-Insurance Protection Act … which sets legal limits to regulators’ jurisdiction over self-insurance health plans by setting unequivocal parameters to define medical stop loss policies and how they are different from traditional health insurance. READ MORE

FAQ Resource Published to Answer Common Questions about Self-Funding

Mar 29, 2017|0 Comments

SFS News Release: FAQ Resource Published to Answer Common Questions about Self-Funding – Adding to its collection of educational resources for consumers, the Self-Funding Success website recently developed an FAQ reference. This piece addresses questions on the basics of self-funded health plans, as well as many others related to costs, planning and implementation. READ FULL RELEASE

A Change for Small Biz Could Cost Some Employers their Custom Health Plans

Mar 21, 2017|0 Comments

Faced with rising premiums in the group health insurance market, the Park Slope Food Coop opted five years ago to create a custom plan for its 74 full-time employees and their family members and pay for the costs directly. “I’m convinced we would have had to raise prices if we weren’t self-insured,” said Joseph Holtz, general manager, who estimates self-insurance saves the co-op $300,000 to $500,000 a year. The co-op is one of several hundred New York employers that will be forced to stop self-insuring next year, thanks to a change in the state’s definition of a small business. READ MORE

MediBid Enhances its Free Market Medical Pricing for Self-Funded Employers

Mar 14, 2017|0 Comments

MediBid, the first online tool empowering patients to seek bids for low priced, high quality medical care, now shares the prices of winning bids to every doctor, hospital, and facility that makes a bid…. “Although there are many vendors in the transparency space, most of them report on PPO allowables, or Medicare rates…. We are the first entity to report on direct pricing.” ….[and] allow providers to compete for patients…. READ MORE

New Resources Developed to Educate Consumers About Self-Funded Health Plans

Feb 24, 2017|0 Comments

SFS News Release: New Resources Developed to Educate Consumers About Self-Funded Health Plans — The Self-Funding Success website recently added several new resources to its Self-Funding 101 section in its ongoing effort to educate consumers. These pieces focus on a variety of elements that contribute to the positive results many employers are experiencing with self-funded health plans – workplace wellness, prescription cost management and price transparency.  READ FULL RELEASE

GPA Saves Clients A Record-Breaking $1 Billion

Feb 22, 2017|0 Comments

Dallas, TX — By consistently providing high quality, cost-effective services to its clients, Group Pension Administration Inc. (GPA) has achieved a record-breaking $1 billion in client savings…. audits on bills from hospitals, emergency rooms, and dialysis centers culminated in GPA reaching its impressive milestone…. READ MORE

Guardian Study Reveals Majority of Employers Overwhelmed With Increased Complexity of Managing Benefits

Jan 31, 2017|0 Comments

Here’s a recent study that indirectly affirms the need for high-quality, full-service TPAs for employers to best manage their employee benefits, maximize cost savings and ensure compliance…  The Guardian Life Insurance Company of America recently released Benefits Balancing Act, the third set of findings from the Fourth Annual Guardian Workplace Benefits StudySM. The research highlights the increasing challenges employers face in managing benefits costs, improving administrative efficiency, and maintaining plan compliance, all while trying to improve workforce health and productivity…. READ MORE

Are Medical Captives the Answer to Data Transparency?

Jan 19, 2017|0 Comments

Medical captive insurance is helping level the playing field for mid-market employers who, along with their brokers and advisers, pledge a more aggressive stance on cost containment….uses a pooling approach to self-fund employers with as few as 25 employees – a strategy that as many as 98% of larger employers have used for years. The cost savings of its stop-loss group captive is 20% on average, which he says is a double-digit advantage over traditional fixed cost health insurance. Under the medical captive model, which helps mitigate self-funding’s volatility challenge…READ MORE

Why Self-Funded Healthcare is a Great Option for 2017

Jan 12, 2017|0 Comments

Small- and mid-sized companies using traditional major medical plans are at a competitive disadvantage: either they are paying more in loaded costs than competitors that use smarter healthcare options, or they are finding it more difficult to hire employees because their competitors offer better plans….With the new year and a new healthcare landscape, HR executives and benefits directors are now reconsidering their options… To balance the scales and create a competitive advantage, more companies are turning to healthcare plans based on a self-funding model…READ MORE

Lack of Price Transparency Leading Employers to Self-Insure

Dec 23, 2016|0 Comments

One employer chose to invest in self-insuring his own company due to a general lack of price transparency seen with payers’ health plans…. the notion of a company self-insuring its employees and dealing with medical claims on its own terms is slowly becoming a more popular option…READ MORE

Effective TPAs Contribute to Self-Funding Success

Nov 28, 2016|0 Comments

One of the most important success factors in self-funding is the service provided by the third party administrator (TPA)…READ MORE

Self-Insurance is Surging: More Transparency, Lower Costs – and More Risk

Oct 19, 2016|0 Comments

Self-insurance for medical benefits is sometimes seen as a step into the unknown. After all, companies are taking on more risk, and the potential for catastrophic medical costs can intimidate some business owners. But many experts say that the potential cost savings outweigh the risk… READ MORE

Companies Move Toward Self-Insurance as Healthcare Rates Increase

Aug 29, 2016|0 Comments

The rising cost of healthcare – and the pressures associated with pushing more of the cost onto employees – is causing a shift to self-insurance among employers… READ MORE

TPA Contains Average Medical Plan Cost Increase to Just 2.05% for its Employer-Clients

Jul 15, 2016|0 Comments

A third party administrator (TPA) with multiple locations in the U.S., Cypress Benefit Administrators has released its annual cost data trends report comparing the average cost increase of its health plans to others throughout the nation… READ MORE

How Organizations Can Benefit from Self-Funding Employee Health Plans

Jul 7, 2016|0 Comments

How to fund health benefits is a major decision for any organization. There are two options — get fully insured through a health insurance carrier or fund it themselves. Until recently, self-funding was only considered for large organizations due to the potential risk involved, but that’s changing… READ MORE

8 Ways to Make the Most of a Self-Funded Health Plan

Jun 30, 2016|0 Comments

For companies that self-fund, unbundling your health plan benefits offers some distinct advantages including competitive rates, more flexibility, and greater transparency… READ MORE

Self-Funded Health Plans Can Save Money, Up Risks

May 31, 2016|0 Comments

Business consulting company Spooner Inc. found itself facing the same challenge its clients and many other employers across the country are grappling with: rapidly rising health plan costs… READ MORE

The ABCs of Self-Funding Your Health Plan

May 27, 2016|0 Comments

More employers are moving to self-funding. Here’s what you need to know to make the switch… READ MORE

2 Ways to Maximize Value in a Self-Funded Medical Plan

Apr 30, 2016|0 Comments

Much has been written about self-funding strategies for employers. Typically, these articles focus on fundamental elements such as understanding and selecting the best contract type, using tiered provider networks, developing and monitoring a well-thought-out and perpetual wellness strategy, as well as the unique flexibility in plan design that is inherent in this approach. That’s smart, and it’s exactly where you should start. However, it’s possible – and prudent – to go much deeper… READ MORE

Selfie Health Insurance is All the Rage

Mar 30, 2016|0 Comments

It is not often that the words elegance and health plan end up in the same sentence, but Steve Gransbury says self-insurance can bring them together—and not just in a sentence… READ MORE

How to Proactively Manage Self-Funded Employer Health Plans

Jan 13, 2016|0 Comments

As more patients join self-funded plans, hospitals face new challenges regarding billing and collection… READ MORE