Self-Funded Health Insurance Solutions

About Micah Chance Healthcare Consulting

Why Choose Us?

Types of Networks

At Micah Chance, we understand that choosing a health insurance plan can be overwhelming. That's why we offer personalized assistance and guidance to help you find the right plan for your needs and budget.

When selecting a health insurance plan for your employees, it's crucial to consider the benefits of a self-funded approach. With our s

When selecting a health insurance plan for your employees, it's crucial to consider the benefits of a self-funded approach. With our self-funded health insurance solutions, you gain control over your healthcare costs while ensuring your employees receive comprehensive coverage and exceptional support. Our self-funded plans offer the flexibility and customization you need to tailor your benefits package to the unique needs of your workforce.

What sets us apart is our comprehensive network of healthcare providers, which ensures that your employees have access to quality care at competitive rates. Whether it's primary care physicians, specialists, or leading hospitals, our network has you covered. With a self-funded approach, you have the freedom to design a plan that meets the specific needs of your organization while maximizing cost savings and minimizing financial risk.

But it's not just about the coverage—it's also about the experience. With our self-funded solutions, you'll have access to dedicated support and resources to help you navigate the complexities of healthcare benefits. From personalized account management to responsive customer service, we're here to ensure that your self-funded plan is implemented seamlessly and efficiently. When you choose us as your self-funded health insurance partner, you're not just getting coverage—you're getting a trusted ally committed to the success and well-being of your employees.

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Hands shaking over health insurance options

Types of Networks

We work with a vast network of healthcare providers to ensure our clients have access to the best medical care possible. Our networks includes top hospitals, clinics, and specialists across the country.

In a self-funded health plan, the type of network included can vary depending on the preferences and arrangements made by the employer. H

In a self-funded health plan, the type of network included can vary depending on the preferences and arrangements made by the employer. Here are some common types of networks found in self-funded health plans:

Preferred Provider Organization (PPO) Network: Many self-funded health plans utilize a PPO network, which offers a wide selection of healthcare providers, including doctors, hospitals, and specialists. PPO networks typically provide greater flexibility for employees to choose their healthcare providers, whether they are in-network or out-of-network. However, employees may pay less out of pocket when using providers within the network.
Exclusive Provider Organization (EPO) Network: Some self-funded health plans may use an EPO network, which is similar to a PPO but typically does not provide coverage for out-of-network care except in emergencies. EPO networks often offer lower premiums compared to PPO networks but still provide access to a broad network of providers within the network.
Health Maintenance Organization (HMO) Network: While less common in self-funded plans, some employers may choose to utilize an HMO network. HMOs typically require members to select a primary care physician (PCP) who coordinates all of their healthcare needs and provides referrals to specialists within the network. HMO networks may offer lower premiums but require more coordination of care.
Direct Contracting Networks: In some cases, employers may opt to directly contract with specific healthcare providers or facilities to provide healthcare services to their employees. These direct contracting arrangements can offer more control over costs and quality of care, but may have a more limited selection of providers compared to traditional network options.
Reference-Based Pricing Networks: Reference-based pricing plans set reimbursement rates for healthcare services based on a reference point, such as Medicare rates or a percentage of billed charges. Employers may use these networks to control costs and promote transparency in healthcare pricing, but they may also require employees to shop around for lower-cost providers.

Overall, the type of networks included in a self-funded health plan can vary based on factors such as cost considerations, employee preferences, and the employer's objectives for the plan. We help employers carefully evaluate their options and consider factors such as network adequacy, provider quality, and employee access when selecting a network for their self-funded health plan.

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Technology

Types of Networks

Technology

We utilize the latest technology to streamline the health insurance enrollment process and make it as easy as possible for our clients.

In a self-funded health insurance plan, various types of technology can be utilized to streamline administration, enhance employee engagement, and improve overall efficiency. Here are some common types o

We utilize the latest technology to streamline the health insurance enrollment process and make it as easy as possible for our clients.

Claims Processing Systems: Advanced claims processing systems automate the processing of healthcare claims, reducing manual errors and speeding up reimbursement processes. These systems often include features such as claims adjudication, electronic claims submission, and real-time eligibility verification. We work with many TPA's that provide many of these services to our clients.
Benefit Administration Platforms: Benefit administration platforms help employers manage and administer their self-funded health plans more efficiently. These platforms typically include tools for plan enrollment, member eligibility verification, premium billing, and reporting and analytics.
Telemedicine and Virtual Care Solutions: Telemedicine and virtual care solutions allow employees to access healthcare services remotely, reducing the need for in-person visits and improving access to care. These solutions often include video consultations with healthcare providers, online appointment scheduling, and mobile health apps for tracking health metrics.
Healthcare Analytics and Data Insights: Healthcare analytics tools provide valuable insights into healthcare utilization, cost trends, and population health metrics. We work with employers to use these insights to identify cost-saving opportunities, track the effectiveness of wellness programs, and make data-driven decisions to improve health outcomes.
Wellness and Health Management Platforms: Wellness and health management platforms help employers promote employee wellness and engagement through various programs and initiatives. These platforms may include features such as health risk assessments, personalized wellness plans, fitness tracking, and rewards and incentives programs.
Decision Support Tools: Decision support tools provide employees with personalized guidance and information to help them make informed healthcare decisions. These tools may include cost estimators, provider quality ratings, and treatment decision support to help employees navigate the healthcare system more effectively.
Member Portals and Mobile Apps: Member portals and mobile apps provide employees with convenient access to their health insurance benefits and information. These platforms allow employees to view coverage details, check claim status, find in-network providers, and access educational resources anytime, anywhere.
Data Security and Compliance Solutions: Given the sensitive nature of healthcare data, data security and compliance solutions are essential components of self-funded plans. Employers should implement robust security measures, such as encryption, access controls, and regular security audits, to protect sensitive health information and comply with HIPAA regulations.

Overall, leveraging technology in a self-funded health insurance plan can help employers enhance the efficiency, effectiveness, and employee experience of their healthcare benefits program. By investing in the right technology solutions, employers can optimize their self-funded plan to meet the evolving needs of their workforce while controlling costs and improving health outcomes.

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Advantages of a self-funded insurance plan

Cost Savings

One of the primary advantages of self-funded plans is the potential for cost savings. Employers can avoid paying the profit margin and administrative fees typically included in traditional fully insured plans. By assuming the financial risk for healthcare claims directly, employers have more control over their healthcare spending and can potentially lower overall costs.

Flexibility and Customization

Self-funded plans offer employers greater flexibility and customization options compared to traditional insurance plans. Employers can tailor the plan design to meet the specific needs of their workforce, choosing benefits, coverage levels, and provider networks that align with their budget and employee preferences.

Transparency

With self-funded plans, employers have more transparency into healthcare costs and utilization. They can access detailed claims data and analyze trends to identify cost-saving opportunities, implement wellness programs, and manage healthcare expenses more effectively.

Cash Flow Management

Self-funded plans provide employers with better cash flow management opportunities. Instead of paying fixed premiums to an insurance company, employers only pay for actual claims incurred by employees. This can help improve cash flow predictability and budgeting accuracy.

Tailored Risk Management

Employers can customize risk management strategies to mitigate financial risk associated with self-funded plans. They can purchase stop-loss insurance to protect against catastrophic claims exceeding a certain threshold, helping to minimize financial exposure while still reaping the benefits of self-funding.

Employee Engagement and Satisfaction

Self-funded plans may offer employees more personalized benefits and access to a broader network of healthcare providers. This can lead to higher employee satisfaction and engagement with their healthcare benefits, ultimately contributing to improved morale and retention within the organization.

Regulatory Flexibility

Self-funded plans are subject to different regulations than fully insured plans, primarily governed by the Employee Retirement Income Security Act (ERISA). While employers must comply with ERISA requirements, self-funded plans offer greater flexibility in benefit design and administration, allowing employers to adapt their plans to changing regulatory landscapes more easily.

Overall, self-funded insurance plans can be a strategic option for employers seeking greater control, cost savings, and customization in providing healthcare benefits to their employees. However, they require careful planning, risk management, and compliance with regulatory requirements to ensure successful implementation and administration.

Frequently Asked Questions

Please reach out to us if you cannot find an answer to your question.

What is the difference between HMO and PPO plans?

The primary difference between fully funded and self-insured health insurance lies in how the financial risk for providing healthcare benefits is managed:

Fully Funded Health Insurance:

In a fully funded health insurance plan, the employer pays fixed premiums to an insurance carrier, typically on a monthly basis.

The insurance carrier assumes the financial risk for providing healthcare benefits to the employees. This means that the carrier is responsible for paying for healthcare claims incurred by employees, regardless of the total amount of claims.

The premiums paid by the employer are pooled with those of other employers in the insurance carrier's risk pool, spreading the risk across a larger population.

The employer's financial liability is limited to the fixed premiums paid to the insurance carrier. Even if healthcare claims exceed the premiums paid, the employer is not responsible for covering the additional costs.

Self-Insured Health Insurance (also known as self-funded or self-insurance):

In a self-insured health insurance plan, the employer assumes the financial risk for providing healthcare benefits to its employees.

Instead of paying fixed premiums to an insurance carrier, the employer sets aside funds to cover the cost of healthcare claims incurred by employees.

The employer has more control over the design and administration of the health plan, including benefit options, provider networks, and cost-saving initiatives.

Stop-loss insurance may be purchased to protect against catastrophic claims that exceed a certain threshold, providing financial protection to the employer.

The employer's financial liability is not limited to fixed premiums, and they are responsible for paying all healthcare claims incurred by employees, up to the level of stop-loss coverage if applicable.

In summary, the key difference is in the allocation of financial risk:

In fully funded health insurance, the insurance carrier assumes the risk, and the employer pays fixed premiums.

In self-insured health insurance, the employer assumes the risk and is responsible for funding healthcare claims directly.

Preferred Provider Organization (PPO) and Health Maintenance Organization (HMO) are two common types of managed care health insurance plans, and they differ primarily in terms of flexibility, cost, and the need for referrals. Here's a breakdown of the key differences between PPO and HMO plans:

Provider Choice:

PPO: PPO plans offer more flexibility in choosing healthcare providers. Members can typically visit any healthcare provider without a referral, whether they are in-network or out-of-network. However, they will pay less out of pocket if they use providers within the plan's preferred network.

HMO: HMO plans usually require members to select a primary care physician (PCP) who serves as the gatekeeper for all healthcare services. Referrals from the PCP are typically required to see specialists, and coverage is usually limited to providers within the HMO network.

Costs:

PPO: PPO plans typically have higher premiums and out-of-pocket costs compared to HMO plans. However, members have the flexibility to see out-of-network providers, albeit at a higher cost.

HMO: HMO plans often have lower premiums and out-of-pocket costs compared to PPO plans. Since members are required to use in-network providers and obtain referrals for specialist care, overall healthcare costs are usually lower.

Referrals and Coordination of Care:

PPO: PPO plans do not require referrals from a primary care physician to see specialists. Members have the freedom to schedule appointments with specialists directly, both in-network and out-of-network.

HMO: HMO plans typically require referrals from the primary care physician for specialist care. The PCP coordinates all aspects of the member's healthcare and must refer them to specialists within the HMO network for coverage.

Out-of-Network Coverage:

PPO: PPO plans offer coverage for out-of-network care, although members will pay higher out-of-pocket costs, such as coinsurance and deductibles, for services received from non-preferred providers.

HMO: HMO plans usually do not provide coverage for out-of-network care, except in emergencies. Members are responsible for the full cost of services obtained from out-of-network providers, except in urgent or life-threatening situations.

In summary, PPO plans offer more flexibility in provider choice and typically have higher costs, while HMO plans prioritize lower costs and require referrals for specialist care. The choice between PPO and HMO plans often depends on individual preferences, healthcare needs, and budget considerations.

What is a self-funded insurance plan?

Self-funded insurance plans, also known as self-insurance or self-funded health plans, are a form of health insurance where the employer assumes the financial risk for providing healthcare benefits to its employees. Instead of paying premiums to an insurance company, the employer sets aside funds to cover the cost of healthcare claims incurred by employees.

How does a self-funded insurance plan work?

Here's a breakdown of how self-funded insurance plans work:

Employer Responsibility: In a self-funded plan, the employer takes on the responsibility of paying for employees' healthcare costs directly. This means the employer is responsible for funding all eligible medical claims, rather than paying fixed premiums to an insurance company.

Customization: Self-funded plans offer employers more flexibility and control over the design and administration of their healthcare benefits. Employers can tailor the plan to meet the specific needs of their workforce, choosing benefits, coverage levels, and provider networks that align with their budget and employee needs.

Risk Management: Self-funded plans carry some level of financial risk for the employer. If employees incur high medical expenses, the employer may have to pay more to cover those costs. However, employers can mitigate this risk by purchasing stop-loss insurance, which provides financial protection against catastrophic claims exceeding a certain threshold.

Cost Savings Potential: One of the primary reasons employers opt for self-funded plans is the potential for cost savings. By self-insuring, employers can avoid paying the profit margin and administrative fees typically included in traditional fully insured plans. Additionally, they have more transparency into healthcare costs and utilization, allowing them to implement cost-saving strategies such as wellness programs and care management initiatives.

Regulatory Compliance: Self-funded plans are subject to different regulations than fully insured plans, primarily governed by the Employee Retirement Income Security Act (ERISA). Employers must comply with ERISA requirements regarding plan administration, reporting, and disclosure to ensure legal compliance.

Employee Benefits: From the perspective of employees, self-funded plans may offer similar or enhanced benefits compared to traditional insurance plans. They may have access to a broader network of healthcare providers and more comprehensive coverage options. However, employees should be aware that the employer ultimately bears the financial risk, which could potentially impact benefit offerings in the future.

Overall, self-funded insurance plans can be a viable option for employers seeking greater flexibility, cost control, and customization in providing healthcare benefits to their employees. However, they require careful planning, risk management, and compliance with regulatory requirements to ensure successful implementation and administration.

What types of Health Insurance plans are there?

Health insurance comes in various forms to accommodate different needs and preferences. Here are some common types of health insurance:

Health Maintenance Organization (HMO): HMO plans typically require members to select a primary care physician (PCP) who serves as the gatekeeper for all healthcare services. Referrals from the PCP are usually required to see specialists, and coverage is usually limited to providers within the HMO network. HMOs often require minimal paperwork and have lower out-of-pocket costs but offer less flexibility in choosing healthcare providers.

Preferred Provider Organization (PPO): PPO plans offer more flexibility in choosing healthcare providers compared to HMOs. Members can usually see any healthcare provider without a referral, but they'll pay less if they use providers within the plan's preferred network. PPO plans typically have higher premiums and out-of-pocket costs but offer more comprehensive coverage and greater provider choice.

Exclusive Provider Organization (EPO): EPO plans are similar to PPO plans but have stricter restrictions on out-of-network coverage. Members are typically only covered for services received from providers within the plan's network, except in emergencies. EPO plans often have lower premiums compared to PPO plans but still offer some flexibility in provider choice.

Point of Service (POS): POS plans combine features of HMO and PPO plans. Members choose a primary care physician and receive coverage for services within the plan's network. However, they also have the option to see out-of-network providers, usually at a higher cost. POS plans typically require referrals for specialist care, similar to HMOs.

High-Deductible Health Plan (HDHP): HDHPs have higher deductibles and lower premiums compared to traditional health insurance plans. They're often paired with Health Savings Accounts (HSAs), which allow members to save money tax-free for qualified medical expenses. HDHPs are designed to encourage cost-consciousness among members and are often chosen by individuals who are generally healthy and don't expect to incur many healthcare expenses.

Catastrophic Health Insurance: Catastrophic health insurance plans provide coverage for major medical expenses after a high deductible is met. These plans typically have low premiums but high deductibles and are designed to protect against significant financial loss from unexpected medical emergencies.

Medicare: Medicare is a federal health insurance program for people aged 65 and older, as well as certain younger individuals with disabilities. It consists of several parts, including Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage plans), and Part D (prescription drug coverage).

Medicaid: Medicaid is a joint federal and state program that provides health insurance coverage to low-income individuals and families. Eligibility criteria and covered services vary by state.

These are some of the main types of health insurance available, each with its own features, costs, and coverage options. It's essential to carefully consider individual healthcare needs and preferences when selecting a health insurance plan.

What information is needed from me to request a quote?

When requesting a group health insurance quote for your organization, you'll need to provide specific information about your company and its employees.

Here's a list of the information commonly required:

Company Information:

Company name

Industry or type of business

Company size (number of employees)

Business address

Contact person (usually the HR manager or benefits administrator)

Contact information (phone number, email)

Employee Information:

Total number of employees to be covered under the group health insurance plan

Census data, including:

Full name of each employee

Date of birth

Gender

Employment status (full-time, part-time)

Dependent information (if applicable), including names and dates of birth

Coverage tier (employee only, employee plus spouse, employee plus children, family coverage)

Tobacco usage status

Any additional eligibility criteria specific to your organization (e.g., length of employment, hours worked per week)

Current Health Insurance Coverage (if applicable):

Details about any existing group health insurance coverage, including the insurance carrier and policy details

Healthcare Preferences:

Desired level of coverage (e.g., basic, comprehensive)

Preferred plan type (e.g., HMO, PPO, EPO, Self-Funded)

Preferred deductible amounts and copayment levels

Any specific coverage requirements or preferences

Budget and Cost Considerations:

Budgetary constraints or financial considerations

Desired contribution structure (employer-paid, employee-paid, cost-sharing)

Renewal Information (if applicable):

Details about your current group health insurance plan, including renewal date and any changes in coverage or premiums

Additional Information:

Any other relevant information or specific requirements for your group health insurance plan

Providing accurate and detailed information will help insurance providers tailor their quotes to meet the specific needs of your organization and employees. Be prepared to answer any follow-up questions from insurance representatives to ensure that the quotes you receive are comprehensive and suitable for your organization's needs.

What factor's affect the cost of health insurance premiums?

Several factors can influence the cost of health insurance premiums. Insurance providers consider these factors when determining the price of coverage. Here are some of the key factors that can affect health insurance premiums:

Age: Generally, older individuals tend to have higher healthcare costs, so premiums for older individuals are often higher than for younger individuals.

Location: Healthcare costs can vary significantly by region due to differences in medical care expenses, provider networks, and state regulations. Premiums may be higher in areas with higher healthcare costs.

Tobacco Use: Tobacco users are at a higher risk for various health conditions, so insurers often charge higher premiums for individuals who use tobacco products.

Plan Type: The type of health insurance plan you choose (e.g., HMO, PPO, EPO, HDHP) can affect premiums. Plans with more comprehensive coverage or broader provider networks may have higher premiums.

Coverage Level: The level of coverage you select, such as bronze, silver, gold, or platinum, can impact premiums. Plans with lower deductibles and copayments typically have higher premiums.

Deductible: The amount you must pay out of pocket before your insurance coverage kicks in can affect premiums. Plans with higher deductibles usually have lower premiums, while plans with lower deductibles have higher premiums.

Coinsurance and Copayments: The percentage of costs you're responsible for after meeting your deductible (coinsurance) and fixed amounts you pay for specific services (copayments) can influence premiums.

Family Size: The number of individuals covered under your health insurance plan, including dependents, can affect premiums. Family coverage often costs more than individual coverage.

Health History and Pre-existing Conditions: Some insurers may consider your personal health history and pre-existing medical conditions when calculating premiums. Individuals with chronic health conditions may face higher premiums.

Employer Contributions: For employer-sponsored health insurance plans, the level of contributions made by the employer toward premiums can impact the amount you pay.

Government Subsidies: Eligibility for government subsidies, such as premium tax credits or cost-sharing reductions, can lower the amount you pay for health insurance premiums, particularly for plans purchased through the Health Insurance Marketplace.

Market Factors: External factors, such as changes in healthcare laws and regulations, market competition, and economic trends, can also influence health insurance premiums over time.

Understanding these factors can help individuals make informed decisions when selecting a health insurance plan and comparing premium costs.

Self-Funded Health Insurance Plans

About Micah Chance Healthcare Consulting

Why Choose Us?

Types of Networks

Types of Networks

Types of Networks

Types of Networks

Types of Networks

Technology

Types of Networks

Technology

Advantages of a self-funded insurance plan

Cost Savings

Flexibility and Customization

Transparency

Cash Flow Management

Tailored Risk Management

Employee Engagement and Satisfaction

Regulatory Flexibility

Frequently Asked Questions

Contact Us

Call us today for your group insurance needs!

Micah Chance Healthcare Consulting

Hours

Drop us a line!

Self-Funded Health Insurance Plans

About Micah Chance Healthcare Consulting

Why Choose Us?

Types of Networks

Types of Networks

Types of Networks

Types of Networks

Types of Networks

Technology

Types of Networks

Technology

Advantages of a self-funded insurance plan

Cost Savings

Flexibility and Customization

Transparency

Cash Flow Management

Tailored Risk Management

Employee Engagement and Satisfaction

Regulatory Flexibility

Frequently Asked Questions

Contact Us

Call us today for your group insurance needs!

Micah Chance Healthcare Consulting

Hours

Drop us a line!

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