Self-Funding or Health Insurance: What's The Difference?

While benefits won’t go into effect until 2028, contributions for the State Plan begin early next year. Now is the time to begin learning about the options and implications of choosing coverage through the State or a Private Plan.

Benefit Indemnity’s use of Reference‑Based Pricing (RBP) delivers significantly greater savings than traditional PPO plans. In recent client case studies, several companies realized savings ranging from ~64% to ~85% compared to typical Medicare-based benchmarks — with most claims processed cleanly and minimal balance-bill issues. The results make a strong case that RBP can outperform PPO networks while still maintaining stability and predictability for employers.

Language can be quite interesting. The dictionary teaches us the definition of words at a young age, but society “teaches” us the meaning of words in today’s social media following world. You may or may not love to be trendy, but can being trendy get you in trouble?

The first thing to know about renewals is that it’s always better to share renewal news—whether it’s good or bad—in person. This is the perfect opportunity to go over the reports and explain how their funds have been used. The aggregate report will show 9 months of claims utilization. Pay special attention to the Year-to-Date Surplus Column to see how your client’s claims are trending. This will give you an idea of whether they’re on track to receive a surplus check at the end of the plan year.

Continuous Education not only brings professional advantages but also supports personal growth. In the insurance industry, ongoing education is especially important because it ensures agents and brokers remain up to date with the latest industry trends, regulations, and product developments.

SUCCESS STARTS WITH YOU. Taking the time to meet with your client and thoroughly discussing the necessary steps to finalize the rates for the Revolution & Precision Health Plans is key.

High Deductible Health Plans (HDHP) don’t need to be qualified for HSAs in order to be effective for groups. In fact, some moderate up front copays covering basic services before the deductible applies is a great way to make a HDHP work better. Create an option that’s not HSA compatible to help some employees and employers maximize benefits AND SAVINGS! By purchasing a HDHP, your client can save a tremendous amount of premium compared to a more traditional style of health plan or HMO. The savings from purchasing an HDHP is often enough to offset or justify the higher deductible on the health plan. This leaves your client in a win-win situation. While this buying strategy has always been available, premium increases have been highly unpredictable. And often this strategy is overlooked in exchange for shopping for the cheapest premium and accepting the inevitable.

In June of 2002, the IRS established a ruling and terminology for what are now known as Health Reimbursement Arrangements (HRAs). An HRA is an extension of a qualified medical reimbursement plan, in which the employer agrees to provide reimbursement for certain employee medical expenses. This process has always enjoyed a tax favored status as employer payments for reimbursement of IRS qualified medical expenses are deductible to the employer and not considered taxable income to the employee. The 2002 ruling added clarification that an employer promise of reimbursement that goes unused in a given year, can in fact, be carried forward for future years’ expenses without adverse tax consequences.

Achieving efficiency in an ecosystem absent of standards presents an insurmountable task. When each provider charges what they will but charges each patient according to the rules of responsible party paying on behalf of each patient’s health plan or absence thereof, we find only chaos. This chaos costs us hundreds of billions of dollars each year in bloated administrative waste and continued financial abuse of the system. According to the JAMA, this number is estimated to reflect “…$760 billion to $935 billion, of the $3.6 trillion the US spends on health care annually” … “is potentially wasteful.”

Health coverage is often taken for granted until it is needed the most. How a person feels about their plan is often determined at that very point. But waiting until that point, or sadly, after it, to understand how the plan works, is too often the case. This results in more work, stress and potentially, unintentional lack of coverage...

Since when does your consumer drive his health plan? Did you know that one study once revealed that the American consumer can guess the price of a Honda within $300, and yet are off by about 50% a four-day hospital stay? Did you also know that 17% of consumers know the cost of their medical treatment BEFORE receiving it?

Consumer Driven Health Plan (CDHP) concepts are built upon the premise of buying less insurance. By using higher deductibles and cost-sharing (such as co-pays and co-insurance) one reduces the insurance costs enough to have money allotted to cover these increased cost sharing items.

A meeting or presentation with a prospective new client can be daunting. Each of us has our own methods of approaching. Over the past 30 plus years, I’ve accompanied many brokers and have seen a wide variety of successful formulas. But one thing rings true to all, and that is, the power of two...

Self-funded health benefit plans offer groups the opportunity to be rated more precisely for their own specific demographic situation that can all add up to great savings for some groups. While not everyone will save, many of your clients may be able to save significant costs on their benefits, compared to the fully insured market place.