Medical

Medical

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All group medical benefit plans fall into one of two categories: self-funded or insured. The choice of one over the other should not be made arbitrarily. Each type carries its own set of administrative rules and legal constraints.

 

Fully Insured Medical Plans

Under an insured health benefit plan, an insurance company assumes the financial and legal risk of loss in exchange for a fixed premium paid to the carrier by the employer.

Types of Fully Insured Medical Plans: Traditional (PPO), HSA, HRA, FSA) {Click Type To Learn More}

These medical plans can be bought traditionally through the carrier, through our Private Exchange, or through Associations. {links to pages about private exchange and associations}

 

Self-Funded Medical Plans

Employers with self-funded (or self-insured) plans retain a portion of the risk of paying for their employees’ health care.

Stop-Loss Insurance

Employers with self-funded health plans typically carry stop-loss insurance to reduce the risk associated with large individual claims or high claims from the entire plan. The employer self-insures up to the stop-loss attachment point, which is the dollar amount above which the stop-loss carrier will reimburse claims. Stop-loss insurance comes in two forms: individual/specific stop-loss and aggregate stop-loss.

Individual/Specific Stop-Loss Insurance

This protects a self-funded employer against large individual health care claims. Essentially, it limits the amount that the employer must pay for each individual.

Aggregate Stop-Loss Insurance

This protects the employer against high total claims for the health care plan.

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