Group Executive Insurance Marketing, Inc. |
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| About Self-Funding FAQ about Group Executive HIPPA Information Enrollment Form Termination Form |
WHAT IS SELF FUNDING? Self-funding is based on the concept that health insurance is designed to protect against two different areas of exposure; predictable costs and unpredictable costs. Predictable costs should be funded and paid by the employer. Purchasing insurance to cover predictable claims is not cost effective due to loads for overhead, taxes, profit, sales commission, reserves, etc., in addition to the full amount of the predictable claims. Self-funding predictable claims can results in a direct saving of medical insurance premium loads. Unpredictable costs, such as shock claims or catastrophic losses, are justifiably insured through an excess-loss contract with an insurance carrier. Premiums are much lower for this type of coverage, so the insurance companies loads are correspondingly lower.
Why Self-Fund?
Increase Cash Flows
Employer Control
IS SELF-FUNDING FOR YOUR COMPANY? · If you have 50 or more employees covered for health benefits, · If you are looking for a way to contain your health care costs, · If you want timely information and reports about your plan,
HOW DOES SELF-FUNDING WORK?
· Excess-loss contracts are available through Group Executive Insurance Marketing, Inc. in two forms: Aggregate excess-loss and Individual excess-loss. These two types of coverage protect the employer's self-funded medical plan from unpredictable losses should there be a year in which either unanticipated or catastrophic claim occurs. · Aggregate excess-loss insurance limits the overall annual claims exposure of the employer's self -funded plan. The employer is expected to fund the predictable claims cost. Predictable (expected) paid claims make up the employer's annual aggregate deductible. If eligible claims paid by the TPA during the contract period exceed the annual aggregate deductible, the aggregate excess-loss insurance reimburses the employer at the end of the contract period for the excess amount
· Individual excess-loss insurance protects the employer's
self-funded plan from losses due to catastrophic claims attributed to any
on individual. A per-person deductible is established based on the size of
the group and the amount of risk the employer wants to assume. If eligible
medical claims paid foe any individual exceed this deductible, the payments
made in excess of the deductible are reimbursed to the employer under the
individual excess-loss insurance contract. Individual and aggregate excess-loss
coverage can be purchased in the following forms:
RESPONSIBLE PLAN MANAGEMENT As medical costs continue to escalate, claims administration and data management become more critical, since claims represent up to 95% of overall self-funded plan costs. Prompt, accurate claim settlement with GEM Claim Our claims analysts are experienced and they understand your plan. With one easy data entry, our GEM Health Claims Management System can verify employee eligibility, compare current charges to prior history, track provider payments and calculate the benefit payment allowed. Claim checks and a corresponding explanation of benefits are produced automatically. Quality assurance Our claims analysts use the GEM Claim system to monitor employee and dependent eligibility. Name changes, per-existing conditions or extension of benefits are updated instantly. In Addition, our people coordinate benefits with other plans or plan limitations and where additional data is required, we follow up immediately. Financial control For self-funded employers, we use our system to manage the loss fund and checking account established for claims. Check register and payment summaries are maintained and billing can be directed to any plant of office location. We provide further assistance in completing necessary federal disclosure forms and provider 1099s. State of the art data analysis
As a fully automated Third Party Administration firm, we provide self-funded
employers with timely, understandable reports on claims experience, provider
practices and funding status. A few of our standard management reports are:
· With our report generator and cost containment reporting, we have the ability to produce several utilization and provider reports. Some of the reports requested most often by our clients are: · Hospital utilization statistics - diagnosis reporting - provider comparison analysis - loss ratio reports - average length of stay (by diagnosis and hospital) - weekend admission reporting (by diagnosis and hospital) - co-payment analysis - attending physician review - length of stay by cause In addition, custom reports may be designed to help employers compare health care providers or analyze plan utilization in further detail.
Email gem@gemtpa.com
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