What is a self-insured group health plan?

Posted: Sat Aug 30, 2008 06:51 am Post Subject:

Hi Fatman,

Let me tell you the basic difference that comes to surface over here-

When I compare the more potential employers with the ones with a lesser potentiality I see that the more powerful ones would have enough fund to support any worth of health care claims. On the other hand the smaller employers would just obtain some kinda stop loss insurance to feed them from losses arising out of claims beyond a certain limit.Such agreements between stop-loss insurers & the employers are not aimed to cover individual plan takers.
Roddick

Posted: Sat Aug 30, 2008 06:55 am Post Subject:

Hi all..thanx so much for your valued information...but now I'm more keen to know about the administrators of such claims that may arise out of self-insured plans which are actually group health plans.
Regards, Fatman

Posted: Sat Aug 30, 2008 07:02 am Post Subject:

Yeah...thats a pretty good question I must say Fatty!
See, self-insured employers could do it in two forms-
* They may control the in-house claims
* They may outsource it to third party administrators (TPAs)

Now, these TPAs are people who would assist these employers to develop self-insurance group plans for health purposes & communicate stop-loss coverage, insurance network agreements & production checking services. Hope you got them all!

Evan

Posted: Sat Aug 30, 2008 07:04 am Post Subject:

Hi Evan, over here I'd also like to ask you a couple of questions..
What are the laws to govern such self-insured group health plans?
Again, Who'd look into the payroll deductions under such systems?
Regards, Roddick

Posted: Sat Aug 30, 2008 07:38 am Post Subject:

Hi..

The following federal laws would govern the self-insured group health plans-

• 
  
• ERISA (Employee Retirement Income Security Act)
  
  
• COBRA (Consolidated Omnibus Budget Reconciliation Act)
  
  
• DEFRA (Deficit Reduction Act)
  
  
• Pregnancy Discrimination Act

Posted: Sat Aug 30, 2008 07:47 am Post Subject:

I think I've got the list completed this time!

* Civil Rights Act
* Health Insurance Portability and Accountability Act (HIPAA)
* Americans with Disabilities Act (ADA)
* Age Discrimination in Employment Act

Evan

Posted: Sat Aug 30, 2008 08:23 am Post Subject:

Hi I guess we should also take the budget reconciliation Acts into account. As far as I remember we do have the following laws that have an unique role to play in it.

(1) Tax equity & fiscal responsibility Act (TEFRA) (2) Deficit Reduction Act (3) Economic Recovery Tax act (ERTA)

Regards, ArindamSenIndies

Posted: Tue Jan 13, 2009 04:28 pm Post Subject:

This business is cyclical. Companies come and go from being self insured to fully insured. They go fully insured for a few years until the fully insured companies raise their premiums out of whack, then they go back to self insured to save money, then their costs get out of control and they get a deal from a fully insured company, then they raise their rates, so they go back self insured. Its the nature of the game now. Companies are doing everything and anything to save money and be able to supply their employees with benefits.

Posted: Tue Aug 04, 2009 06:28 am Post Subject: self-insurance fees

Why are there fees levied on self-insurers in the proposed bill? Does that amount to a penalty for not opting for the government plan? What reason is there for imposing those fees?

Posted: Tue Aug 04, 2009 06:42 am Post Subject: self-insurance fees

In the new health care bill before congress, why are fees levied for self-insurers? what is the purpose of these fees? Are they an attempt to discourage self-insuring? Is charging a fee in these circumstances a reasonable thing to do? What do the fees pay for? Does that amount to a penalty for self-insuring?