Self-Funded Medical Plans
Self-funded medical plans are for employers with more than 100 enrolled employees.
Financing health care through a self-funded arrangement means you pay for your health care claims plus an administrative fee and a network access fee. You may also purchase the security of stop-loss coverage to ensure your working capital is not overwhelmed by a large claim.
When you choose the self-funded financing option, the TPA will process and pay claims for your covered individuals (known as members) according to the terms of the benefit options you have chosen.
The TPA, or carrier, will bill you for the:
- Claims amount paid during the prior month
- Administrative fees
- Network access fee
- Stop-loss premium, if applicable
- You retain responsibility for the payment of benefits under your plan.
Advantages of Self-funded:
- Your company’s cash flow may improve because you maintain your own reserves
- You choose weekly cash transfers or monthly billing
- You pay premium tax on the stop-loss coverage only
- Monthly reports provide detail of your group’s actual claims utilization
- You save if your group’s claims utilization is lower than expected
- Specific and aggregate stop-losses limit your group’s financial liability
Contact your ENV agent today to see if self-funding your health plan is right for you.