Medical and Dental Self-funded Accounts

My exposure to the self-funded concept began in 1980 with a large municipal employer.  Since that time we have used this concept to the advantage of numerous small and medium sized employers.  It seems to work best for groups that have specific ideas and needs and adequate cash flow.  Excess loss insurance mitigates the amount of risk and makes it manageable.  The bottom line is that over time self-funding produces the most value for your benefit dollars, but it is not right for everyone.

Our service to clients in this area is to provide them with an analysis of self-funding versus fully insured.  Therefore, in addition to the fully insured portion of a complete benefit plan, the following aspects are explored:

            Choosing a third party administrator

            Selecting the appropriate excess loss insurance

            Designing and communicating the plan of benefits

            Helping with auditing and financial statement preparation

            Compliance Issues

            Choosing appropriate networks

            Funding claims payments

            Integrating HRA, FSA and HSA plans

            Selecting an appropriate PBM