Controlling Health Care Costs With Self-Funded Plan Options

05 Aug at 1:00 - 2:30 pm EST Duration 90 minutes Credits SHRM, NASBA, HR Certification Institute

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Understand the advantages and potential concerns that come with self-funding and whether it’s the right decision for your organization.

Healthcare costs are constantly on the rise, and the cost to employers and employees is only becoming more of a burden. Traditional insurance carriers often offset these increasing costs by raising copays and deductibles, and employers paying the premiums find themselves having to shift the increased costs to their employees. Through self-funding, however, employers can tailor the benefits offered to their employee populations, which can prove more cost-effective for both employers and employees.

Self-funding involves a more hands-on approach by involving buy-in from employers and employees alike to fully realize its advantages. As a small trade-off for the cost-savings and ability to customize benefits to an employer’s workforce, employers and their TPAs must address certain plan design and compliance considerations. This material will provide a framework for the self-funding industry by describing the various concerns of which employers must be aware with an eye toward maximizing benefits while minimizing costs.

Learning Objectives

  • You will be able to define a self-funded health plan and what distinguishes it from a fully insured plan.
  • You will be able to describe a number of the advantages and potential concerns that come with self-funding.
  • You will be able to discuss key considerations relevant to designing a robust self-funded plan.
  • You will be able to recognize and distinguish plan incentives vs. employer incentives and relevant considerations.

Agenda

Overview of Self-Funded Plans
  • Governing Law (e.g., ERISA, ACA, HIPAA, FMLA, COBRA, Mhpaea)
  • Benefits of ERISA Preemption
  • Important of Strong Language in the Spd
  • Compliance Concerns
  • Benefits of Self-Funding vs. Fully Insured
  • Risks of Self-Funding vs. Fully Insured
Employer/Employee Cost Sharing in Self-Funded Plans
  • ACA Changed the Landscape
  • What Employee Is Paying vs. What Employer Is Paying
Stop-Loss Insurance, Reinsurance and Other Options
  • Stop-Loss Is a Specific Type of Reinsurance
  • Stop-Loss Regulated by State Law
  • Deductibles, Aggregate vs. Specific
  • Level Funding
  • Captives
  • Duration of a Policy Has a Lot of Options/Implications
Designing Your Plan
  • Compliance Considerations
  • The Relevant Players
  • Choosing and Administrator
Cost Control Measures for a Self-Funded Plan
  • Overall Considerations
  • Employer Incentives
  • Plan Incentives
  • Carve Outs (e.g., Dialysis, Specialty Drugs)
  • Medical Tourism
Case Examples
  • The Phia Group Health Plan

Who should attend?

This live webinar is designed for human resource managers, benefits administrators, controllers, CFOs, presidents, vice presidents, business and office managers, and insurance professionals..

In Partnership with Lorman


Your Instructor


Nicholas Bonds, Esq.
Nicholas Bonds, Esq.
  • Health Benefits Plan Administration Attorney at The Phia Group, LLC
  • Member of the Independent Consultation & Evaluation (ICE) team, working on consultation, plan document review, and regulatory compliance
  • Regular contributor to Phia articles, blogs, podcasts, and webinars
  • Member of the Massachusetts Bar Association
  • J.D. degree, New England Law | Boston, with a certificate in intellectual property law; B.A. degree in history, with a minor in biology, McMurry University

Kelly E. Dempsey, Esq.

The Phia Group, LLC

  • Vice President of Consulting at The Phia Group, LLC
  • Concentrates in various aspects of self-funding, health care, and employee benefits, specializing in plan document drafting and review, as well as a myriad of compliance matters
  • Frequent speaker for industry webinars and client conferences
  • Written multiple industry publications and contributor to online media content
  • Ohio State Bar Association member
  • J.D. degree, Cleveland-Marshall College of Law; B.S. degree in both psychology and business, Muskingum University (formerly Muskingum College), graduating magna cum laude

Credits

OnDemand Course

This course was last revised on December 14, 2015.

This program does NOT qualify, nor meet the National Standard for NASBA accreditation.

Live Webinar Registration

  • HRCI Approved ProviderHR Certification Institute 1.5
  • This program has been approved for 1.5 (General) recertification credit hours toward aPHR(TM), aPHRi(TM), PHR®, PHRca®, SPHR®, GPHR®, PHRi(TM) and SPHRi(TM)recertification through HR Certification Institute® (HRCI®). For more information about certification or recertification, please visit the HR Certification Institute website at www.hrci.org.
  • SHRM-CP/SHRM-SCP Preferred ProviderSHRM 1.5
  • Lorman Education Services is recognized by SHRM to offer Professional Development Credits (PDCs) for the SHRM-CPSM or SHRM-SCPSM. This program is valid for 1.5 PDC(s) for the SHRM-CP or SHRM-SCP.
  • National Registry of CPE SponsorsCPE 1.8 including Personnel/HR 1.8
  • Lorman Education Services is registered with the National Association of State Boards of Accountancy (NASBA) as a sponsor of continuing professional education on the National Registry of CPE Sponsors. State boards of accountancy have final authority on the acceptance of individual courses for CPE credit. Complaints regarding registered sponsors may be submitted to the National Registry of CPE Sponsors through its web site: https://www.nasbaregistry.org/cpas/complaints. For more information regarding administrative policies such as complaint and refund, please contact our offices at 866-352-9539. CPE Credit: Maximum Credit Hours: 1.8 each session (based on a 50 minute credit hour). You must attend at least 50 minutes to obtain credit. Field of Study: Personnel/HR for 1.8 hours. Prerequisite: . Level of Knowledge: Intermediate. Teaching Method: Seminar/Lecture. Advance Preparation: None. Delivery Method: Group Internet Based. Please refer to the information in this brochure for outline, course content and objectives. Upon completion of this course, you will receive a certificate of attendance. Final approval of a course for CPE credit belongs with each state's regulatory board. Please note: In order to receive CPE credit for this course you MUST use the streaming audio option, as well as enable and complete the required progress checks.

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