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Controlling Health Care Costs With Self-Funded Plan Options

Understand the advantages and potential concerns that come with self-funding and whether it's the right decision for your organization.

Healthcare costs are constantly on the rise, and the cost to employers and employees is only becoming more of a burden. Traditional insurance carriers often offset these increasing costs by raising copays and deductibles, and employers paying the premiums find themselves having to shift the increased costs to their employees. Through self-funding, however, employers can tailor the benefits offered to their employee populations, which can prove more cost-effective for both employers and employees. Self-funding involves a more hands-on approach by involving buy-in from employers and employees alike to fully realize its advantages. As a small trade-off for the cost-savings and ability to customize benefits to an employer's workforce, employers and their TPAs must address certain plan design and compliance considerations. This material will provide a framework for the self-funding industry by describing the various concerns of which employers must be aware with an eye toward maximizing benefits while minimizing costs.

106 minutes
Course Exam
Certificate of Completion
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Why Lorman?

Over 34 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

Agenda

Overview of Self-Funded Plans

  • Governing Law (e.g., ERISA, ACA, HIPAA, FMLA, COBRA, Mhpaea)
  • Benefits of ERISA Preemption
  • Important of Strong Language in the Spd
  • Compliance Concerns
  • Benefits of Self-Funding vs. Fully Insured
  • Risks of Self-Funding vs. Fully Insured

Employer/Employee Cost Sharing in Self-Funded Plans

  • ACA Changed the Landscape
  • What Employee Is Paying vs. What Employer Is Paying

Stop-Loss Insurance, Reinsurance and Other Options

  • Stop-Loss Is a Specific Type of Reinsurance
  • Stop-Loss Regulated by State Law
  • Deductibles, Aggregate vs. Specific
  • Level Funding
  • Captives
  • Duration of a Policy Has a Lot of Options/Implications

Designing Your Plan

  • Compliance Considerations
  • The Relevant Players
  • Choosing and Administrator

Cost Control Measures for a Self-Funded Plan

  • Overall Considerations
  • Employer Incentives
  • Plan Incentives
  • Carve Outs (e.g., Dialysis, Specialty Drugs)
  • Medical Tourism

Case Examples

  • The Phia Group Health Plan
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Why Lorman?

Over 34 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

Credits

OnDemand Course

This course was last revised on August 5, 2021.

Call 1-866-352-9540 for further credit information.

  • HR Certification Institute 1.75
     
  • This E-Learning program has been approved for 1.75 (General) recertification credit hours toward aPHR(TM), aPHRi(TM), PHR®, PHRca®, SPHR®, GPHR®, PHRi(TM) and SPHRi(TM)recertification through HR Certification Institute® (HRCI®). For more information about certification or recertification, please visit the HR Certification Institute website at www.hrci.org.
     
  • SHRM 1.75
     
  • Lorman Education Services is recognized by SHRM to offer Professional Development Credits (PDCs) for the SHRM-CPSM or SHRM-SCPSM. This program is valid for 1.75 PDC(s) for the SHRM-CP or SHRM-SCP.
     

To earn each credit Lorman offers through the OnDemand learning platform, you need to watch 100% of the program. Also, for certain credits you will need to fulfill additional requirements which will be displayed on the "credits" tab when viewing the course.

  • Those applying for AIA and HRCI must view 100% of the program and answer the questions following the program.

This program does NOT qualify, nor meet the National Standard for NASBA accreditation.

MP3 Download

This program does NOT qualify, nor meet the National Standard for NASBA accreditation.

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Why Lorman?

Over 34 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

Faculty

Nicholas Bonds, Esq.

Nicholas Bonds, Esq.

The Phia Group, LLC

  • Health Benefits Plan Administration Attorney at The Phia Group, LLC
  • Member of the Independent Consultation & Evaluation (ICE) team, working on consultation, plan document review, and regulatory compliance
  • Regular contributor to Phia articles, blogs, podcasts, and webinars
  • Member of the Massachusetts Bar Association
  • J.D. degree, New England Law | Boston, with a certificate in intellectual property law; B.A. degree in history, with a minor in biology, McMurry University
  • Can be contacted at [email protected]
Kelly E. Dempsey, Esq.

Kelly E. Dempsey, Esq.

The Phia Group, LLC

  • Vice President of Consulting at The Phia Group, LLC
  • Concentrates in various aspects of self-funding, health care, and employee benefits, specializing in plan document drafting and review, as well as a myriad of compliance matters
  • Frequent speaker for industry webinars and client conferences
  • Written multiple industry publications and contributor to online media content
  • Ohio State Bar Association member
  • J.D. degree, Cleveland-Marshall College of Law; B.S. degree in both psychology and business, Muskingum University (formerly Muskingum College), graduating magna cum laude
  • Can be contacted at [email protected]
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Why Lorman?

Over 34 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

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Product ID: 408914
Published 2021
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