That’s the way insurance works for small companies. For most dioceses (and larger employers), the insurance company administers the coverage but it is provided by the employer. The insurance company pays for the claims out of the money the employer has set aside or paid up-front. If there is money left over (after paying the administration expense), it generally rolls into the following year’s pool of money.
WHAT? That model is true only for a non-profit (ie, an HMO like Kaiser Permanente - which happens to be my medical provider). A for-profit insurance company (the large majority of medical providers) is FOR PROFIT. Any profits are paid to the owners (the shareholders) or reinvested in some way. They are NOT returned to the policy holders (customers) - that would defeat the whole concept of “for profit.” A “for-profit” business makes money from its customers; it does not give that money back to its customers.
Insurance companies make money when they are very good at predicting risk (the job of brilliant people called actuaries). A group policy is cheaper than an individual policy because risk is easier to calculate for a group (statistical norms become more reliable).
If the claims exceed what the employer has already put into the pool, the employer pays the difference at the end of the plan year.
No, absolutely not. What you are describing is no different than if the employer was self-insured (ie, no insurance company involved). Most employers (even HUGE multi-billion Euro worldwide corporations such as my employer, with hundreds of thousands of employees) are NOT self-insured - precisely because they do not want to manage the risk. They pay a fixed premium negotiated on an annual basis, and will never pay a dime more (even if the provider is a non-profit). Next year premiums might go up, but there are no retroactive premiums. (Actually this might not be true outside of the United States - my employer is based in Germany, but we’re talking only about US law here, and my coverage options are through US providers).
Some employers purchase separate insurance against catastrophic expenses that might make a single year (or a few) out of the norm.
Not employee health insurance coverage - there’s no such thing. There are always disaster riders for hurricanes, earthquakes, etc. Some employers offer disability insurance, but this is a completely separate policy, and not an extension of medical insurance (and perhaps not even provided by the same company - mine is not).
As noted on the USCCB website, in states that have mandated ABC coverage, the Church has been able to stay in compliance by self insuring all of the insurance or at least the prescription drug portion of the coverage. The new HHS mandate would not allow that configuration.
Yes, I understand. Some Dioceses have been able to bypass private insurance and provide coverage themselves, and thus avoid any requirements that the private insurance companies offer prescription coverage for birth control. But I don’t understand why that is necessary in the first place. Which is my whole point.
The employer doesn’t see individual claims but they do see a summary report. (ie $XX paid for office visits, $XX paid for prescription coverage, $XX paid for outpatient surgery, $XX paid for cancer treatments, etc.)
No they absolutely do not!!! This is insurance company “corporate trade secrets.” Insurance companies absolutely guard this information with their corporate lives! They do not disclose it to ANYONE. This is what they pay their actuaries big bucks to predict. Their livelihood depends on their actuaries predicting these expenses accurately so that they can offer policies expensive enough to cover their costs + earn profits, but not so expensive that they are out-bid by competitors. It’s a fine line, and they closely guard this financial information. If this information became known to their competitor’s actuaries, they could use this information to more accurately predict expenses (because the competitor’s actuaries could build more accurate statistical models - more data equals greater accuracy). Insurance is about one thing, and one thing only - risk management. If you do not understand risk, you cannot manage it. And if you help your competitors understand risk better, you loose.
Insurance companies (if they are publicly traded) disclose the total liability of claims, but NEVER break it down in any way.
You clearly have no idea how insurance works, and are simply making this up as you go along.
Of course, they certainly aren’t “impartial” but their information is accurate and pretty matter-of-fact.