Self-Insure

[PumpkinAle]

Company is moving to self-insure.

The company are sneaky bastards so does anyone know anything about this and whether it is good for the employee?

Thank you.

[cyberswede]

1. Do you mean...

your company is no longer going to provide health insurance as a benefit of employment? And that employees will need to purchase their own insurance?

Companies usually do things that are good for the company; if it's also good for the employees, it's usually just a side-effect.

[bluestate10]

10. Self insurance means that the company acts as the insurance company in paying

benefits. A company doing self insurance works well if most employees are healthy and few big claims are filed. Self insurance can be a disaster if one or more employee becomes seriously ill, requiring expensive long term hospitalization.

[M0rpheus]

2. Moving to a self-Insured plan is not a bad thing by itself.

Your company will be paying all the claims with the insurance company as the recordkeeper.

This can result in lower costs generally, but all it takes is a few big claims for the company to decide to pass some of those costs to you via higher premiums.
It can also allow more/less flexibility in what's covered as your company makes the decision, since they're ultimately footing the bill.

It's a double edged sword. Whether it's good for the employee ultimately depends on whether your company is making the switch to provide better care, save money or, both.

[PumpkinAle]

3. Thank you

they have openly said they want to save money while continuing to offer health benefits.

So we will see.

[M0rpheus]

6. If you have any ongoing health issues that are currently covered...

You'll want specifics from the administrator on continuation of care so there aren't any surprises.

Ask all the questions you can think of and take note of anything that might be a potential problem for you, just in case you need to follow up.

Do you know who the administrator of the plan is/will be? - Just a question to satisfy my curiosity.

[PumpkinAle]

13. Thanks and nope not yet.

n/t

[Loudly]

4. It means that the Company is going to keep your premiums and pay your claims.

They are attempting to cut out the insurance company profit.

If they are doing business in multiple states, they may also find it useful in standardizing benefits across the organization which dealing with different state-regulated insurers might not be able to accomplish for them.

Chances are that they will be using a third-party administrator to process claims, however.

[Hoyt]

5. It's a pretty common thing for companies with more than several hundred employees.

How good it is for you depends on who they choose to administer the plan, and what deductibles, coinsurance, and other restrictions they stick on employees.

Often employees won't see a lot of difference from a fully insured plan. Usually some insurance company carries the risk above what the company is willing to assume (like when a bunch of employees get very sick during the year). Essentially the company has enough employees to take some of the risk, and avoid the insurance company making as much profit.

I worked for a self insured company that had a very good plan. If you had good insurance before, the self-insured plan will probably be good unless the employer has become greedy.

Good luck.

[Blue Diadem]

7. Years ago, my husband's employer was self-insured.

I don't know if all plans work the way ours did, but his company used health insurance companies to handle the claims. Each year we'd receive our insurance cards for whatever plan they'd gone with and it was no different for us from regular health insurance. We had 80/20 for years then they went to HMO's until the company closed in the late 90's.

[PumpkinAle]

8. Thank you everyone for your answers

I am still skeptical because the premiums were very high before and the coverage not that good.

[handmade34]

11. not pertinent to your post

but your name made me think of this awesome stuff...


[URL=.html][IMG][/IMG][/URL]

[PumpkinAle]

14. Hmmmmmmmm beer

Is that just a local brew?

Me thirsty!!!

[handmade34]

16. excellent brew

seasonal from a Vermont microbrewery...

[PumpkinAle]

17. Lucky, lucky you

May your glass always be full of the good stuff!

[bluestate10]

9. Some companies self insure and have done so well before the ACA.

If the prospect of employee claims is low, and serious illness isn't highly probable, self insurance allows a company to earn money on money that would have been paid for premiums. The move could be political, or it could be due to economics.

[Freddie]

12. My employer does this

I'm benefits admin. Started it 2 years ago after being with a BC PPO for many years. BC still administers, employees still get cards from them, they really see no difference. It's done through a 3rd party administrator. They also keep a catastrophic component in case someone needs a heart transplant or such. Has (supposedly) kept our premiums from rising as much as they are somewhat "eliminating the middleman". Very common with large employers like school districts.

[PumpkinAle]

15. Thanks - I do have one question

who gets to see the actual medical ailments that would require procedures, time-off, etc.

I am thinking if someone say had cancer - could the company know and then decide they don't really need that person?

[Freddie]

18. Most large employers use a third party administrator

I know my bosses don't see names on the reports.
However I do understand your concern and I think there is potential for abuse. A relative of mine was mysteriously let go after she had expensive surgery; her employer was self-insured and we both think that was the reason. Ask these questions to your HR people if you can.

[PumpkinAle]

19. Thank you again

I am starting a list.

I hope your relative is doing okay.