West Virginia Self-Funding Basics - Self-Funded and Partially Self-Funded Insurance Plans
With a self-funded arrangement, the employer assumes the health plan liability and risk in exchange for more significant control over the plan’s administration and funding levels. This is different from a traditional fully insured plans in the fact that the insurance company assumes all of the risk, controls the plan administration, establishes reserve capital levels and manages other major decisions concerning the health care coverage provided to employees and dependents.
When a company decides to self-fund its health plan, it can purchase excess insurance coverage to protect itself from large claims and utilization. This excess insurance is called employer stop-loss or ESL coverage. In addition to covering the potential losses inherent with any group benefit plan, ESL coverage provides protection for the entire covered group, reimbursement for medical expenses above a specified dollar amount, and cover for catastrophic and high dollar claims such as transplants, leukemia, renal failure and premature births.
We have partnered with the top independent TPA (Third Party Administrator) in the region, capable of handling clients from 50 to 5,000 lives.
Deacon & Deacon Insurance Agency and our TPA will make every effort to provide competitive proposals to current and prospective employer groups in West Virginia. Our target market for this style of plan is 50-5,000 employees.
Listed below is the information generally needed in order to provide a credible quotation:Current benefit plan design If currently partially self funded, current specific deductible, specific and aggregate contract types
Two years of claims and enrollment experience, preferably by month
Large claim disclosure including amount of claim, diagnosis and prognosis if available
Current employee census
Name and number of years with current carrier
Current and renewal rates
Type of industry
Effective date
If multi-site, zip codes for all employees to evaluate managed care networks
Contact us today to discuss Self-Funded and Partially Self Funded Plans in West Virginia
