So, What is Self-funding?
Does it seem like your company’s health care spending is equal to the gross national product of a small country? It’s ok to admit it. If you have a stake in employee benefits, you know that workforce wellness and benefits plans are changing at a rate faster than most can follow. Switching to a self-funded plan from Lifetime Benefit Solutions can help. You’ll pay only for what you need and use. Plus, with zero premium taxes and lower administration costs, it can add up to some really impressive savings.
Rather than paying a monthly premium to a commercial insurer, you’re responsible for paying for your employees’ health care claims directly. In other words, you pay the covered claims. You also pay an administrative fee to a Third Party Administrator (TPA) to handle the paperwork, while you pocket the savings. Remember, we’re here to help! Our experts are here to show you how the process works and make the transition smooth.
How Does it Work?
- You use a provider network
- Your employees receive a customized ID Card
- You can keep the same benefit levels
- Your annual health care costs will vary based on your employees' claims
- Costs are lower; no state mandates
Why Consider Self-funding?
The savings are big. Even if your group isn’t.
Groups with as few as 150 members and $500,000 total health care spend may save more than $50,000 per year by choosing a self-funded plan from Lifetime Benefit Solutions. Larger groups may save even more!
Why consider self-funding? The savings are big. Even if your group isn’t.
Compare a Fully-Insured Plan vs. a Self-Funded Plan
from Lifetime Benefit Solutions*
* Example includes health care reform taxes, fees and mandates required for 2014. This is an example of one plan for illustration purposes; all plan fees and savings are different.
Self-funding fast fact 61% of all covered workers in the U.S. benefit from some form of self-funded health plan. Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2013.
Ever Wish You Could Design Your Own Health Insurance Plan?
Well, you can. Our benefits programs are built around you. With a self-funded approach, you choose the benefits and extras. You’ll have control without the restrictions, because your plan doesn’t need to adhere to many of the state mandates. This gives you the flexibility to create a plan that’s perfect for your company.
So, What’s in it For You?
- Greater control over expenses
- Improved cash flow, since premiums are not paid in advance to an insurance carrier
- Increased flexibility, because you only pay for the “extras” if your company wants and needs them
- Investment income benefits your company, not a health plan
- Lower cost of administration
- No collateral or bonding requirements
- Reduced premium tax
Sit back, relax. This is what a TPA does for you:
- Day-to-day operation of the health plan
- Give you easy access to plan information and reporting
- Handle claims and benefit processing
- Prepare employer reports
- Process eligibility/enrollment
- Provide customer service for employees
- Report claims usage
Keep these points in mind when selecting a TPA:
- Accurate claims processing
- Easy-to-use online tools
- Exceptional customer service
- Extensive network and discounts
- Flexibility in plan design
- Patient advocacy with case management
- Risk reduction programs
We’re Here to Help.
You’ll have a dedicated team to implement your health plan, handle claims administration and help you initiate cost-reduction and engagement strategies.
You’ll Benefit From:
- Extensive experience in the design and administration of self-funded employee benefit programs
- Full range of services, including claims administration, utilization management, underwriting, actuarial
- Stop loss protection, if you choose to purchase it
- High-quality customer service for you and your employees
Efficient, accurate claims administration
- Plan design
- Electronic, web and paper enrollment
- Custom ID cards
- Appeal administration*
- Benefit booklets*
- Benefit summary grids
- Claim payments
- Compliance services*
- Coordination of Benefits (COB)
- Electronic eligibility review
- HIPAA Certificate of Coverage
- Plan documents
- Provider network access
- Web-based reporting
- Toll-free customer service
*Additional fees may apply.
Appropriate, Cost-Effective Care
Our team of nurses closely monitors your claims to keep your costs in control. Professionals are available to assist you and your employees in obtaining appropriate, costeffective care.
Managed prescription drug costs
In collaboration with the nation’s leading Pharmacy Benefit Managers:
- Claim detail is captured in our system so prescription and medical claim history is available to nurses for case management.
- Our pharmacy team audits claims to ensure accurate discounts, copays and formularies.
Great coverage at home, nationwide
Not only do we offer an extensive, proprietary New York state network, we’ve also contracted with numerous national provider networks to deliver outstanding care to you and your employees, regardless of your location.
Stop loss protection
To help minimize your risk, stop loss insurance is available for purchase, to protect you from extremely high claims.
Steps to Success
Well. Well. Well. Keep your budget and employees healthy with Steps to Success workplace wellness. Any TPA can provide claims processing. But we bring you so much more. We offer Steps to Success — a measurable, five-step employee wellness program designed to help your employees get healthy, stay healthy and lower claims.
- 1. Create awareness and engagement with guidance, free materials
- 2. Conduct health screenings and assessments on-site
- 3. Deliver screening results to employees and doctors on a secure website
- 4. Provide access to health improvement tools and coaching
- One-on-one telephone wellness coaches
- Monthly newsletters
- Better nutrition and successful weight-loss tools
- Preventing and managing back pain
- Controlling asthma, preventing diabetes, managing high blood pressure and more
- Smoke Free For Life® program (for an additional fee)
- 5. Identify and support chronic care participants with state-of-the-art data mining
- Send preventive screening reminders
- Develop care management plans
- Prevention, forecasting and care management helps prevent high-cost health problems
Steps to Success – 2015 Highlights
- 52 companies participated in the wellness program with 25,000 active members
- Industry leading participation rate of 99%
- Identification of 794 Cancer or pre-Cancer cases with 89.5% treated for less than $8,000 each
- 2015 savings is $8.2 million on early Cancer detection and treatment alone
- Exceptional satisfaction surveys with 100% satisfaction rating
Have we piqued your interest?Take the next step. Let’s see how much you can save on your health care plan.
You’ll find us here, ready to help you every step of the way. Let one of our experts help you understand your options and make the right choice for your organization. You’ll see how we can help you manage your costs, minimize your risk and maximize your savings.
Contact us today!
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