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Self-funded health insurance
Benefits & Compensation
Self-funded health insurance
Exchange ideas about health plans, retirement, work/life benefits, and employee assistance.
We are considering a self-funded health insurance plan and would like feedback from companies that are currently self-funded. We have approximately 90 employees and the plan we are looking into is Gre
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Forums » Topic Forums » Benefits & Compensation » Self-funded health insurance
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Self-funded health insurance
posted at 9/8/1999 7:16 PM EDT
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Posts: 3
First: 9/8/1999 Last: 9/30/1999 |
We are considering a self-funded health insurance plan and would like feedback from companies that are currently self-funded. We have approximately 90 employees and the plan we are looking into is Great West.
Any information will be helpful. |
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Self-funded health insurance
posted at 9/27/1999 1:51 AM EDT
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Posts: 99
First: 6/22/1999 Last: 12/11/2001 |
My previous company also had a self-funded plan with Great West. Although I wasn't there when the contract was set up, it seemed to work well but hit hard when one of our executives had a heart attack. Also, when terminations/layoffs occurred, costs went up due to those employees getting everything done before their coverage ended. The plan was a PPO.
We did have an exception to the plan benefits. One of our engineers had plastic surgery that was not a covered benefit although Great West never actually said so. She went through the pre-approval process, even had documents from Great West that they were reviewing her case, looking at the models of her jaw structure (she had part of her jaw removed to fix her bite)and had the names of RN's looking at the case. Both the surgeon & the employee received the standard letter from Great West, ie, "we can't tell you what the benefits are as it is determined at the time of treatment" as they want the employee currently covered at time of treatment. At no time did their letters state it wasn't a covered benefit. Well, about 3 months into the post-op, Great West requested a refund from the surgeon of monies they had erroneously paid to him as the surgery was not a covered benefit. After 5 months of fighting with Great West, afterall, what is the use of pre-approval if they don't tell you the procedures is covered/not covered, we had an option. (In addition, Great West had paid her visits and her hospital bill and was not asking for a refund of this money.) Because of being self-funded we could make the decision to pay all or a part of her claim that was outstanding which amounted to almost $10,000, outside of our plan with Great West. We decided to pay a part of her claim due to Great West's inability to inform her properly. If she had known that the surgery was not a covered benefit, she would have either waited to get the requried funds or not have it at all. You need to review any tax advantages of having a self-funded plan and work with your insurance broker to provide a "guesstimate" of how much it will cost in the initial year. Then you estimate the following year. Your insurance broker will have information on costs, etc. using this type of plan for your comparison. |
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Self-funded health insurance
posted at 11/18/1999 4:47 AM EST
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Posts: 19
First: 9/15/1999 Last: 3/3/2001 |
I've always been cautioned against self-funding for small groups, but the consultant helping you with the project should know more about this than I. As I suggested to another query, however, we love our self-funded dental and vision plan. You've got flexibility, great cost control and it's yours. The only downside is making sure you find a good provider network to contract with. We are currently in the process of contracting with another TPA to administer the plan and we'll use their provider network. |
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