How to guide for transitioning from fully insured planned to a self-funded or partially self-funded insurance plan. Look at what is best for your company and if a self-funded plan is better for you and your employees. We at Premier Insurance strive to satisfy our clients and we will do our best to provide you with the information you need to make an informed decision. We will help you assess what is best for your company.

1. Self Funding
Health Benefits
for Businesses

2. Are you a Good Candidate?

3. Are you a Good Candidate?
● High employee
participation (75%)

4. Are you a Good Candidate?
● High employee
participation (75%)
● An employer that takes
a long-term view of its
medical plans

5. Are you a Good Candidate?
● High employee
participation (75%)
● An employer that takes
a long-term view of its
medical plans
● Financially stable
organization

6. Are you a Good Candidate?
● High employee
participation (75%)
● An employer that takes
a long-term view of its
medical plans
● Financially stable
organization
● Healthier workforce

7. Advantages...

8. Advantages...
1. Lower Fixed Costs

9. Advantages...
1. Lower Fixed Costs
● Manage variable claim
costs=less than
premium charged

10. Advantages...
1. Lower Fixed Costs
● Manage variable claim
costs=less than
premium charged
● Robust risk
management=greater
savings

11. Advantages...
2. Greater Flexibility and
Control of costs

12. Advantages...
2. Greater Flexibility and
Control of costs
● No modified community
rate

13. Advantages...
2. Greater Flexibility and
Control of costs
● No modified community
rate
● Premiums based on
singular risk
profiles/mod factor

14. Advantages...
3. Better Access to Claims
Data

15. Advantages...
3. Better Access to Claims
Data
● Develop targeted risk
management programs

16. Advantages...
3. Better Access to Claims
Data
● Develop targeted risk
management programs
● Meet specific needs of
employees

17. Advantages...
4. Elimination of Most
Premium Taxes

18. Advantages...
4. Elimination of Most
Premium Taxes
● Most plans do not pay
state premium taxes

19. Advantages...
4. Elimination of Most
Premium Taxes
● Most plans do not pay
state premium taxes
● Save more money

20. Save More Money...

21. Save More Money...
1. Comprehensive
Programs

22. Save More Money...
1. Comprehensive
Programs
● Deliver Multiple Benefits

23. Save More Money...
1. Comprehensive
Programs
● Deliver Multiple Benefits
● Prevention and Wellness services

24. Save More Money...
2. Sustainable
Strategies for
Managing Healthcare
Costs

25. Save More Money...
2. Sustainable
Strategies for
Managing Healthcare
Costs
● Provide the incentives to ensure high levels
of participation in wellness programs

26. Save More Money...
2. Sustainable
Strategies for
Managing Healthcare
Costs
● Provide the incentives to ensure high levels
of participation in wellness programs
● Focus on identifying preventable risks and improve
compliance with chronic conditions

27. Save More Money...
2. Sustainable
Strategies for
Managing Healthcare
Costs
● Provide the incentives to ensure high levels
of participation in wellness programs
● Focus on identifying preventable risks and improve
compliance with chronic conditions
● Employ data to determine cost drivers and the highest levels of risk

28. Save More Money...
2. Sustainable
Strategies for
Managing Healthcare
Costs
● Provide the incentives to ensure high levels
of participation in wellness programs
● Focus on identifying preventable risks and improve
compliance with chronic conditions
● Employ data to determine cost drivers and the highest levels of risk
● Gauge the year-to-year financial impact of focused wellness programs

29. Other Lifestyle Modification
Programs...

30. Other Lifestyle Modification
Programs...
● Smoking cessation

31. Other Lifestyle Modification
Programs...
● Smoking cessation
● Pre-diabetes
Education

32. Other Lifestyle Modification
Programs...
● Smoking cessation
● Pre-diabetes
Education
● Exercise programs

33. Other Lifestyle Modification
Programs...
● Smoking cessation
● Pre-diabetes
Education
● Exercise programs
● Weight management

34. Other Lifestyle Modification
Programs...
● Smoking cessation
● Pre-diabetes
Education
● Exercise programs
● Weight management
● Stress management

35. Stop-Loss Insurance...

36. Stop-Loss Insurance...
Specific Stop-Loss
Insurance

37. Stop-Loss Insurance...
Specific Stop-Loss
Insurance
● Specific Deductible

38. Stop-Loss Insurance...
Specific Stop-Loss
Insurance
● Specific Deductible
● Reimburse employer for cost over
SSL claim amount

39. Stop-Loss Insurance...
Specific Stop-Loss
Insurance
● Specific Deductible
● Reimburse employer for cost over
SSL claim amount
● Protects employer against
catastrophic claims from
individuals

40. Row 1 Row 2 Row 3 Row 4
0
2
4
6
8
10
12
Column 1
Column 2
Column 3
Reduce Your Risk

41. Row 1 Row 2 Row 3 Row 4
0
2
4
6
8
10
12
Column 1
Column 2
Column 3
1. Cover organ
transplants
separately
Reduce Your Risk

42. Row 1 Row 2 Row 3 Row 4
0
2
4
6
8
10
12
Column 1
Column 2
Column 3
1. Cover organ
transplants
separately
● Having this
policy separate
can protect you
from unexpected
costs.
Reduce Your Risk

43. Row 1 Row 2 Row 3 Row 4
0
2
4
6
8
10
12
Column 1
Column 2
Column 3
2. Address
specialty
pharmaceuticals
1. Cover organ
transplants
separately
● Having this
policy separate
can protect you
from unexpected
costs.
Reduce Your Risk

44. Row 1 Row 2 Row 3 Row 4
0
2
4
6
8
10
12
Column 1
Column 2
Column 3
2. Address
specialty
pharmaceuticals
● 300 drugs
considered
specialty-this
plan will reduce
cost by
obtaining
discounts
1. Cover organ
transplants
separately
● Having this
policy separate
can protect you
from unexpected
costs.
Reduce Your Risk

45. Row 1 Row 2 Row 3 Row 4
0
2
4
6
8
10
12
Column 1
Column 2
Column 3
3. Manage
dialysis
treatment
Carefully
Reduce Your Risk

46. Row 1 Row 2 Row 3 Row 4
0
2
4
6
8
10
12
Column 1
Column 2
Column 3
3. Manage
dialysis
treatment
Carefully
● Contract with
dialysis
management
specialists to
control costs
Reduce Your Risk

47. Row 1 Row 2 Row 3 Row 4
0
2
4
6
8
10
12
Column 1
Column 2
Column 3
4. Encourage
employees to
manage chronic
conditions
3. Manage
dialysis
treatment
Carefully
● Contract with
dialysis
management
specialists to
control costs
Reduce Your Risk

48. Row 1 Row 2 Row 3 Row 4
0
2
4
6
8
10
12
Column 1
Column 2
Column 3
4. Encourage
employees to
manage chronic
conditions
● Patients who
follow doctors
instructions are
more likely to
reduce billing
costs
3. Manage
dialysis
treatment
Carefully
● Contract with
dialysis
management
specialists to
control costs
Reduce Your Risk

49. Making the Transition...

50. What should you look
at to ensure an easy
transition from a fully
insured plan to a self-
funded arrangement.
Making the Transition...

51. ● Employee Demographic
What should you look
at to ensure an easy
transition from a fully
insured plan to a self-
funded arrangement.
Making the Transition...

52. ● Employee Demographic
– Determine the best type and level of a self-funded
plan that suites your companies needs.
What should you look
at to ensure an easy
transition from a fully
insured plan to a self-
funded arrangement.
Making the Transition...

53. ● Premium Outflow and Claims
Experience
– Do a comparison of premiums
versus claim costs to assess your
fully insured rates
Making the Transition...

54. ● Risk Appetite
– The Stop-Loss insurance will cover what your
claims can't absorb
● Premium Outflow and Claims
Experience
– Do a comparison of premiums
versus claim costs to assess your
fully insured rates
Making the Transition...

55. ● Plan Design and Admin. Options
–
Making the Transition...

56. ● Plan Design and Admin. Options
–
Making the Transition...

57. ● Plan Design and Admin. Options
– Work with our Brokers to satisfy the
needs of both employer and
employee.
Making the Transition...

58. ● Plan Design and Admin. Options
– Work with our Brokers to satisfy the
needs of both employer and
employee.
– We want ensure quality experience
with the appropriate mix of
premiums, deductibles and out-of-
pocket expenses.
Making the Transition...

59. ● Medical Management Service
Costs
Making the Transition...

60. ● Medical Management Service
Costs
– Determine what vendors and how
many vendors is appropriate for
your company
Making the Transition...

61. I
Information gathered from AmWINS Group Benefits: Self-Funding Guide