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Resource Center
Self Funding
With health care costs on the rise every year, how do you continue to provide the
high level of health care your employees deserve while controlling benefit costs to keep your bottom
line staying just as healthy?
Consider the benefits of a self-funded health plan. After all, self-funding can help to reduce your
health plan costs while optimizing your plan resources giving you more control of how your money is
spent. Being in control of how your health care dollars are spent could be the most significant decision
you make about the health of your company and the health of your employees this year.
Self-funded plan benefits include:
• Lower Cost of Administration:
Employers find that administrative costs for a self-insured program administered
through a TPA are significantly lower than those included in the premium by an insurance carrier or
an HMO.
• Carrier Profit Margin and Risk Charge Eliminated:
The profit margin and risk charge of an insurance carrier/HMO are eliminated for
the bulk of the plan.
• Elimination of Most Premium Tax:
There is no premium tax on the self-insured claim expenditures. Premium tax is applied
only to the stop-loss premium, which is a fraction of a fully insured premium.
• Cash Flow Benefit:
The employer's cash flow is improved when money formerly held by the Insurance carrier
in the form of reserves, for unreported and pending claims, is freed for use by the employer.
• Control of Plan Design:
The employer has complete flexibility in determining the appropriate plan design
to meet the needs of the employer and employees. The employer can redesign its plan at any time.
• Mandatory Benefits are Optional:
State regulations mandating costly benefits are optional because self-funding is
regulated by federal legislation only.
• Cost Reporting:
The TPA provides a monthly detailed reporting of costs, by department or location,
and by type of medical service. Utilization and lag reports as well as fund disbursement journals are
also available.
To learn more about how a self-funded health plan can help you achieve a healthier
bottom line, contact us for a complete presentation detailing the full range of benefits, as well as
recommendations into a plan design, that will fit your company's size and needs.
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" I am very pleased with the service I receive from PPHN's medical management department. When we need
an authorization for a patient, it is always done quickly. They are very efficient, and always eager
to help."
- Beverly L. Miller Reading Berks Physical Therapy
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