Chocolate soufflé. Even the most experienced chefs have a hard time making the perfect soufflé. It’s a dish famously known for its level of technicality as well as food expertise, so jumping in the kitchen to whip this up is no cakewalk. If you thought you were reading an insurance blog but turned into a foodie’s daydream of dark chocolate, bear with me, I promise there’s a point. Health insurance is a lot like baking a cake. The right recipe and ingredients make all the difference. So, if traditional insurance was a plain chocolate cake, self-funded plans are a chocolate soufflé. A little more technical but a lot more rewarding.
As health costs continue to rise employer groups are searching for solutions to meet their needs, and it starts with getting the right chef. When it comes to health insurance there is indeed no one-flavor fits all. Self-funding is the best vehicle to curb the persistent cost increases we find in healthcare.
WHAT IS SELF-FUNDED INSURANCE AND MORE IMPORTANTLY, WHY SHOULD YOU CARE?
Unlike the traditional fully insured model, in self-funded plans employers only pay claims as they occur instead of up-front premiums. Groups no longer pay for the whole cake, just the slices they’re eating. Paying claims as they occur gives companies unique insight to make more data driven decisions on their customized plans. Only paying for what employees need improves cash flow by cutting down on historical premium costs.
WHAT GOES INTO SELF-FUNDING?
If health insurance was a recipe, you can think of Apta like having all the main ingredients plus an entirely stocked pantry of different spices. We understand each company has unique needs and different taste in flavor. We have solutions to fit the need of every employer and contain costs based on their unique population. If you wanted something closer to your traditional health plan, we would still have those main ingredients, but if you want to add spice (as much or as little as you want) we’re there to build it for you.
We start with a network of doctors and medical providers that make the most sense for each company. We consider the quality-of-care of providers as well as the location of their offices to make sure your care is always accessible. Next, we have a third-party administrator to do everything your typical carrier would do, like pay claims. We plug in latest and greatest, cutting-edge solutions to enhance the plan – we call these superchargers because they take the plan to the next level. Our implementation team seamlessly integrates all program components and hands it off to our service team to handle day-to-day issues. You don’t need to handle the complexity of implementing or managing a self-funded program. We do that for you so you can focus on building your business.
Additionally, to limit financial risk and hedge against large claims or over utilization by plan members (eating too much cake), we shop stop-loss insurance and deliver greater discounts because of our high-performance program that’s been independently validated by The Validation Institute.
There are two types of stop-loss insurance that can be purchased to make sure the employer isn’t
assuming all the risk:
Specific Stop-Loss Insurance protects from large, catastrophic claims like cancer or organ donation. When tragedy hits, the stop-loss carrier pays out the claim once the employer has met their deductible.
Aggregate Stop-Loss Insurance protects the plan from over-utilization from a company’s entire population. So even if every employee broke an arm and a leg, companies are only required to pay a set amount before their aggregate stop-loss insurance kicks in.
WHAT ARE THE RISKS AND REWARDS OF SELF-FUNDING?
Risks:
Transference of risk to the employer instead of the insurance company. (Though stop-loss caps the risk is at your comfort level.)
Rewards of self-funding through Apta:
Potential for significant savings over fully insured health insurance.
Long-term net savings.
On-call care coordinators.
Apta Cash - the ability to benefit from pre-negotiated cash payments for select procedures.
Flexibility in plan designs and ability to add cost-saving components.
Complete access to all claims data.
Advanced reporting that leads to greater transparency and insight to plan utilization and spending so you can tailor a program to the needs of your population.
With the limitless choices in self-funded ingredients, we have fully baked programs that help brokers bring the best plan to their clients. These programs are built for people who want to take control of their healthcare spending, offer better benefits, and have greater insight into what is driving costs.
Some recipes are more technical than others, let us help you build the best program together, schedule an appointment with us today.
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