What would it mean if you found a health plan solution that ticks all the boxes?
✓ Flexibility
✓ Cost savings
✓ Increase healthcare transparency
These are just some of the benefits that a self-funded insurance model offers to employers and their employees.
Over the past two decades, self-funded insurance has gained popularity among US employers, with an impressive 65% of the workforce covered by self-funded insurance plans in 2021.
So, what exactly is self-funded insurance?
With self-funded insurance, the employer assumes the financial risk and provides health benefits directly to their employees. Whereas with a fully-funded model, an employer purchases insurance from an insurance company, which manages the financial risk on behalf of the employer.
Self-funded insurance plans give employers more control over how their health plan is designed. By customizing these plans, employers can better meet the unique health needs of their workforce and significantly reduce overall claims expenses.
Here are some things to consider before moving plans:
1. Tailored plan design options
Self-funded insurance introduces a world of strategic decision-making for employers. You’ll have the flexibility to choose from a wider network of providers and vendor partners, opening doors to a proprietary network.
If health claims are lower than expected, you can channel those savings towards optimizing your health options. You may consider expanding your wellbeing programs, patient advocacy initiatives, clinical care management, fertility care, maternal care, or behavioral health programs.
With a self-funded plan, you have the unique option to tailor your plan with what is going to be most impactful for your employees’ health: rejecting the “one-size-fits-all” approach of the past.
2. Better healthcare choices
If your goal is to help your employees get the best care at the best price, you’ll want to lean into the experts to ensure they are empowered on their health journey.
Third-party administrators (TPAs), like Personify Health, are your trusted partners to support your plan administration, design, and tackle the hurdle of enrollment and processing medical claims.
TPAs can also help manage financial risk through cost-containment solutions, such as pharmacy benefit management, clinical care management, and employee advocacy programs.
3. Cut costs management with a PBM
Let’s talk about pharmacy benefit managers (PBMs). A PBM is like a TPA, but only in connection to a prescription drug program.
The PBM is responsible for processing and paying prescription drug claims. They also negotiate discounts and rebates with drug manufacturers, contract with pharmacies, and develop and maintain drug formulary.
4. Improve the employee experience
Will employees know right away whether they are on a fully insured plan or a self-funded plan? Probably not. They’ll still receive their member ID cards, access an online portal with insights into covered and non-covered services, and they’ll have their claims processed as they normally would.
But! They will feel the difference in other ways.
Self-funded insurance opens the door to potential savings for employers.
These employers who cut costs in one way can redistribute these savings in another. Employers may offer additional benefits like wellbeing programs or health plan discounts. Incentives for participating in wellbeing programs can be a game-changer for your employee engagement strategy, too!
With a self-funded plan, employees gain access to top-quality care, affordable pharmacy costs, and reduced out-of-pocket expenses.
Take the next step for your employees & your business
When self-funded insurance and TPAs join forces, employers can truly take control of their healthcare costs. With fewer regulations and lower administrative costs, managing those expenses becomes simpler and more efficient.
The costs of your employee health plans is directly influenced by the number of enrolled employees and the overall health of an organization. So, the healthier your employee population, the lower the plan costs for you as an employer.
Which leads us to ask: What could your workforce do if they were at their healthiest?
Can one health platform improve how businesses approach healthcare? That’s our plan.
Connect with a member of the Personify Health team to learn more about how we can partner as your TPA for the road ahead.