If your employer chooses to self-fund their health care plan, they assume financial responsibility for the entire cost of covered medical claims. This includes both routine and catastrophic claims. Employers may purchase so-called stop loss insurance to help protect them against very high costs. In addition, the employer must fund claims during a year when cost growth exceeds expected costs.
As a result, employer-funded plans are subject to different rules and regulations than fully insured plans sold through the ACA marketplaces. The majority of large employers offer self-funded health care coverage to their employees. For example, self-insured employers are not required to comply with ACA’s three-to-one premium limit, which limits how much more premiums increase for older enrollees than for younger ones.
Despite the challenges, some companies are finding ways to reduce costs for their self-insured plans. For instance, some have opted to move their benefits from a large group insurer to a third-party administrator that can take on the responsibilities of managing network negotiations and overall plan administration (such as pharmacy benefit managers).
Other employers have changed their health care plan designs in response to rising costs. For example, Technology Container Corp., a manufacturer of plastic reusable boxes, is changing its plan in 2024 to focus more on reducing out-of-pocket costs for its employees. This may mean introducing a lower deductible or changing the coinsurance and/or copayments. The company also wants to make it easier for its employees to get medical bills paid, which could require a shift away from the traditional process of submitting receipts for reimbursement. Осигуровки самоосигуряващо се лице 2024