Though self-funded health care plans offer employers significant financial benefits, self-funding is not without risk. Self-Funding Partners works with employers, managing all aspects of their health care benefits plan, in order to achieve the perfect balance between risk and return.
Stop-Loss Insurance With self-funded plans, if claims are lower than anticipated the employer can receive the unspent funds. But what happens if claims are higher than expected? Stop-loss insurance protects employers from higher than average or catastrophic claims for individual issues, by covering the excess costs, thus limiting the financial risk. Stop-loss insurance premiums are part of the fixed cost of a self-funded plan.
Protection Contracts (Re-insurance) Also known as aggregate stop-loss, protection contacts apply in cases where claims for the entire organization are higher than projected, limiting the dollar amount of eligible expenses that an employer would pay, in total, during a contract period. The carrier reimburses the employer after the end of the contract period for aggregate claims.
Stop-Loss Carrier Audits When there is a stop-loss audit of any dollar consequence, or when the stop-loss carrier has reason to be unsure as to the practices followed by the plan supervisor, there may be an audit. These audits are conducted either on-site or in our office. Before an on-site audit occurs, members of our staff coordinate a meeting time with the claim payer and review all essential information relating to the process of claim adjudication.
Legal Counselors Laws and Regulations shape all aspects of America’s health care industry, from the flow of dollars to the communication between physicians and patients. It is the engine that translates public policy into action. Self-Funding Partners relies on the legal counsel of The Cronin Law Firm, PLLC in order to ensure that your company is always in compliance with not only state, but federal laws and regulations.