MEDICAL STOP LOSS

Self-Funding

Self-funding presents a significant opportunity for employers to save money on their healthcare plans. Self-funding offers greater flexibility in plan design along with lower administrative …

Self-funding presents a significant opportunity for employers to save money on their healthcare plans. Self-funding offers greater flexibility in plan design along with lower administrative costs. Most importantly, under a fully insured plan the employer pays a fixed annual premium whether employee medical expenses are lower or higher than the premium paid. With a self-funded plan the employer keeps the difference if the annual claim fund is lower than employee medical expenses

Level Funding

Level funding combines the flexibility and cost saving opportunities of self funding with the fixed and predictable monthly costs of a fully insured plan. If the claim funding dollars amount to less …

Level funding combines the flexibility and cost saving opportunities of self funding with the fixed and predictable monthly costs of a fully insured plan. If the claim funding dollars amount to less than the claims paid by the end of the year, the employer receives a check for the difference. Like self-funding, the employer’s overall financial exposure is limited by specific and aggregate stop-loss insurance.

Reference Based Pricing

Reference Based Pricing (RBP) is a niche in the self-funded market where claims are paid according to a percentage of the Medicare schedule rather than utilizing a traditional PPO network  …

Reference Based Pricing (RBP) is a niche in the self-funded market where claims are paid according to a percentage of the Medicare schedule rather than utilizing a traditional PPO network. There are many benefits of an RBP platform compared to the typical PPO arrangement, some of them being lower overall claim costs, more predictable costs and lower future trend increases, and a wider selection of providers. All platforms have vendor and legal support which assists employees with the process to make the transition as simple as possible.

Captive

Captive programs are utilized for clients to stabilize rate increases over time by a form of pooling risk. Employers with a healthy population typically look to captives to receive the justified minimal rate …

Captive programs are utilized for clients to stabilize rate increases over time by a form of pooling risk. Employers with a healthy population typically look to captives to receive the justified minimal rate increases as well as a potential to share in accumulated reserves. Captive programs have certain requirements for admittance in terms of plan design and cost containment measures. AccuRisk provides specific and aggregate stop loss coverage to mitigate the risk to the captive due to catastrophic or higher than expected frequency of claims.

Provider Sponsored Plans

Provider Sponsored Plans are a way for employer clients to directly contract with healthcare providers in order to obtain lower reimbursement rates. Employees are typically incentivized to use the …

Provider Sponsored Plans are a way for employer clients to directly contract with healthcare providers in order to obtain lower reimbursement rates. Employees are typically incentivized to use the provider’s facilities, which have lower contracted prices compared to other providers in the area. The provider receives more patients and higher utilization at their facilities, while the employer self-funded plan is paying less for services. AccuRisk works with TPA’s and providers to develop the plan and provides specific and aggregate stop loss to plan sponsors.