Self-funded: An Option for All Employers?

    • December 18, 2018
    150 150 M.E. Wilson

    Have You Considered Self-funding?

    by Justin Treece


    Employers across the country are now considering the option of self-funding with greater frequency than in the past. As companies weigh their options, employers both large and small are finding the self-funded or partially self-funded model more accessible. Once only considered an option for larger employers (over 1,000 employees), the self-funded option’s perceived financial risk is no longer weighing as heavily smaller companies’ decisions.

    Before deciding on this topic, employers should consider the following questions.

    What are the benefits of self-funding?

    For some employers, the choice of working with a fully funded carrier is an easy one to make. In fact, it is oftentimes the path of least resistance. For other employers, the financial benefits that come with self-funding are well worth the perceived risk. Fully funded plans allow for a fixed monthly expense and no volatility in cash flow on a month to month basis.  However, within a fully insured group experiencing better than expected claims, there is no incentive.  Whereas, in a self-funded environment, an employer only pays for the actual claims incurred over the course of the plan year as well as fixed costs for administration of the plan and the reinsurance purchased to set caps on both an individual and an aggregate protection levels. Beyond this, self-funding allows for greater flexibility.  To remain competitive, employers can create benefit plans that best meet the needs of their employees and what is required in their industry.  Also, taxes and fees paid on the insurance premiums are mitigated in a self-funded plan, thus resulting in additional plan savings.             

    How much am I risking if I have an aged employee population or we face a devastating medical claim?

    Due to an aging population and workers remaining in the workforce longer, an increase of claims can sometimes occur. As we age, additional medical care and/or treatments is oftentimes needed. Unfortunately, there is no way to predict a major accident or when a critical illness may affect someone’s health. Larger employers are better equipped for these concerns for they often have reserved funds to cover claims. On the opposite end, smaller employers could take a devastating loss in the event of one of these claims. However, there are options that exist to help protect employers. Aforementioned, Stop-loss insurance helps protect employers if a claim exceeds a particular individual or aggregate dollar amount. Before choosing to self-fund, employers should talk to their consultant about stop-loss coverage and weigh which options are best for their business.

    How will I equip myself with everything I need to best run my health plan?

    A strong consultant in combination with a good administrator will afford an employer the tools necessary to run a company’s health plan. However, there are many solutions and options that may help in the reduction of healthcare costs. Cost-saving tools and strategies such as PPO and narrow networks, reference-based pricing, Benefits Captives, true pharmacy controls, health and performance, disease management and medical tourism all may be options to help control the healthcare spend of an employer.

    Employers should have a conversation with their benefits consultant about the option of self-funding. The options made available may help in the improvement of a company’s employee benefits program and in cost-savings.