C
Corki
Guest
Thanks. You explained that much more precisely than I did.30% of employers are self insured. In a self insured scenario, the employer is the plan administrator. They contract with an insurance company that acts as a Third Party Administrator that generates it’s profit through Administrative Services Only fees. It rents it’s network to the employer, pays the claims on the employer’s behalf, and works with the employer on plan design.
The employer takes on the risk, and generally buys Stop Loss insurance to pay for catastrophic claims. All claims as paid by the employer, from a combination of employee contributions (so called premiums) and employer funds. The employer is responsible for determining employee contributions and for tracking Incurred But Not Realized (IBNR) costs to ensure that they have enough money on hand to pay the claims.
But, the problem with the HHS mandate is that to design a plan without contraceptive coverage (if you offer drug coverage) would be illegal and the TPAs would not comply.
I also found this link about self-insurance.
siia.org/i4a/pages/Index.cfm?pageID=4546