WHAT DOES SELF-FUNDED MEAN?

Although Self-Funding is often construed as being too risky, a properly designed program actually contains more risk protection than traditional insurance programs; at the same time affording increased flexibility in plan design, administration and improved claims service to the employees. As more and more employers understand this funding method, many have left the days of paying high insurance premiums and found they save hundreds of thousands of dollars while achieving much greater control over this incredibly large expense.

Self-funding provides many advantages that may not be available to groups maintaining a traditional fully insured benefit plan. Rather than having to choose from a series of pre-packaged options, self-funding provides broad flexibility in plan design and costs.

WHY SELF FUND?

We help you design your employee benefit package from basic to the most comprehensive. You, as an employer, are involved from the beginning in customizing your employee benefit package. The beauty of self-funding is the flexibility in designing a benefit package to fit both your employees and your budget.

MEDICAL: Providing medical coverage to your employees and their dependents is the vital core to any employee benefit package. We have excellent working relationships with several local, regional and national Preferred Provider Networks (PPOs) and Exclusive Provider Networks (EPOs) to help assure the best coverage available. Managed care networks can be a very effective tool for containing costs. A well-structured strategy for its implementation and/or maintenance can preserve the savings while avoiding the pitfalls that do exist. We will assist in defining what you consider adequate access and then determine where (if any) network coverage is deficient.

DENTAL: Dental insurance is a great way to increase employee satisfaction and decrease turnover rate. These plans can be installed on a voluntary basis, or the employer may pay part of the cost. Either way, it is one of the best benefits that we can offer an employee.

VISION:

PRESCRIPTION DRUG CARD: The Prescription drug card program has been found to be the most popular benefit among plans that offer it. The key to success is in designing a benefit that meets the needs of the employees and yet protects the financial integrity of your plan.

RE-INSURANCE: To guard against catastrophic claims, we help employers secure Stop Loss coverage. This allows the employer to define the maximum liability they can handle per employee per year. Stop Loss insurance covers any claims over this amount. We have preferred relationships with several "A" rated reinsurers.

PARTIALLY SELF-FUNDED: In addition to fully-insured programs, MCC, INC. has applied its managed care and product desugn expertise to the development of a "packaged" partially self-insured product. This product, MCC, Inc. Advantage, has been designed to help remove the guesswork from the self-funding of a medical benefits program for small to intermediate group employers. MCC, Inc. Advantage provides ease of administration. Its packaged structure allows groups to enjoy cost-saving benefits and controls of self-funding without the attendant hassles. From self-funded employee benefits services to fully-insured carrier-based programs, MCC, Inc. is equipped to provide businesses with the very best in quality managed care products and services.

ACHIEVING CONTROL THROUGH SELF-FUNDING

Greater financial control and cash flow advantages are generally the reasons an organization chooses to self-fund its employee benefits plan. But the additional flexibility available through self-funding also has the potential to reduce overall health benefit costs because of the following advantages:
1. Premium tax does not apply to self-funded claim funds in most states
2. Insurance carrier costs, risk charges and plan operating expenses are reduced
3. Self-funded programs are regulated by ERISA, and therefore avoid costly benefits mandated by state regulation
4. Organizations realize the full and immediate advantages of favorable experience and do not pay for the potentially poor history of another group's claims

1. CASH FLOW CONTROL
With traditional insurance or HMO coverage, your premiums usually do one of two things each year at renewal. If you have had poor claims experience, your premiums will go up a lot. If you have had good claims experience, your premiums will go up a little. Either way, your premiums continue to escalate year after year. With self-funding, you pay only for the claims actually incurred by the members of your group.
Therefore, if the money is not used for claims, it is retained by the group. Furthermore, your cash flow is improved because money previously held by the insurance carrier (as reserves and surpluses belong to you for unreported claims) is also retained by the group.

2. CONTROL OF PLAN DESIGN
Self-insured plans, unlike traditional insured plans or HMO coverage, are not regulated by the state.
Instead, they are covered under federal ERISA regulations (the TPA we use will file this for you). Costly state-mandated benefits can be avoided and your self-funded plan can be tailored to meet your needs. Plan design for maximum cost containment coupled with more employee participation.

3. COST & UTILIZATION CONTROLS THROUGH MANAGED CARE
You will have the best managed care program (designed to make medical care cost-effective) without compromising quality. Using medical management programs such as Pre admission Certification and Large Case Management.

4. LOWER COST OF OPERATION
You will find that administrative costs for self-insuring your group health plan will be lower that those being charged by traditional insurance plans or HMO coverage. Administrative costs such as risk charges, commissions and start-up fees, are greatly reduced. In addition, there are no premium taxes for this type of plan.

5. RISK MANAGEMENT THROUGH STOP-LOSS INSURANCE
As a self-insured employer, you assume only the risk of the predictable claims for your group. Unusually large claims and unexpected heavy group utilization are still insured through the use of loss or stop-loss insurance. Your liability is limited to an amount that can be easily budgeted, per participant, just like a premium. The difference is you don't release funds until payment is needed for claims or administrative costs.

6. ACCURATE, COMPREHENSIVE REPORTING
You will be able to track claim dollars and know exactly where your money is going. The TPA we use will supply an array of accurate management reports to meet your specific needs.

7. EFFICIENT CLAIMS PROCESSING
Our success working with TPA'S depends largely upon prompt and accurate claims processing and friendly customer service. References available upon request.