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SELF-FUNDING HEALTH BENEFITS. Two ways to illustrate Self-Funding. A.Follow the money Fully Insured Self-Funded B.The Extra “0” Plan What is an HRA. Why it works. An illustration comparing Fully Insured to Self-Funding Industry-wide stats on health and utilization - PowerPoint PPT Presentation
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SELF-FUNDING HEALTH BENEFITS
Two ways to illustrate Self-Funding
• A. Follow the money– Fully Insured– Self-Funded
• B. The Extra “0” Plan– What is an HRA
Why it works
A. An illustration comparing Fully Insured to Self-Funding
B. Industry-wide stats on health and utilizationC. Grid comparing Fully Insured to Self-FundingD. Who is a good candidate?E. Case Study
Stop Loss
A. What it is
B. Contract Types
Two ways to implement Self-Funding
A. Baby Stops
B. The Big Bang (for your buck)
Evaluating & Purchasing Stop Loss Insurance
• Terminal Liability Option (TLO)• Monthly Aggregate Accommodation• Specific Advance Funding• Rate Caps• Aggregating Specific• Options for Groups Under 100 ee’s
Myths & Misperceptions
A. Busy, Busy Bee
B. Lasers – the boogeyman in the closet
C. The monster under your bed – looming large claimant
D. Run-Out – the Grasshopper & The Ant
E. Maximum Liability – chicken little syndrome
F. No Guaranteed Renewal – too many fish in the sea
G. The Ugly Step-Sister – ugly renewals
How Self-Funding works with a TPA
A. The key elementsB. Pharmacy BenefitsC. PPOsD. Maximum cost containment is more than a
PPO discountE. Minimizing Future RisksF. Administrative Services Only (Carrier) vs. TPA
Grid
Questions & Answers
