Industry expertise and world-class service for the self-funded healthcare market

Our top priority is to provide products and services that give our policyholders peace of mind when they need it most. We strive to meet policyholder needs with our commitment to underwriting excellence, consummate claims handling and exceptional customer service. Our regional market underwriters have full and final binding authority giving producers and customers a single point of direct contact for both marketing and underwriting.

The basics of self-funding

  • ESL coverage is an excess risk product for self-funded employers.
  • Self-funding is an alternative funding method under which group benefits are provided as opposed to the fully insured group contract.
  • Self-funded employers control:
    • Vendor selection
    • Plan design
    • Capital and risk management
    • Administrative and operational expenses
    • Health plan spend
  • The employer assumes risk of the benefit plan and purchases excess loss coverage for protection against serious individual catastrophic claims and/or high group utilization.
  • Self-funded plans are governed by the Employee Retirement Income Security Act (ERISA) - the federal act of 1974 that exempts self-funded plans from restrictive state mandates.
  • Employer selects the service of:
    • Insurance carrier for excess loss coverage (Specific and Aggregate Stop Loss)
    • Third Party Administrator (TPA) or Administrative Services Only (ASO) carrier to:
      • Adjudicate claims / administer benefit plan
      • Access cost-containment vendors including preferred provider organization (PPO) networks, case management utilization review and wellness programs.
      • Access to other service vendors including pharmacy benefits manager, dialysis manager, transplant network and mental health providers.

Fully insured groups wanting to transition to self-funding now have an option!

Swiss Re Corporate Solutions has been leading the market by enabling current fully insured groups the opportunity to consider self-funding.  Since many fully insured groups are unable to obtain the historical claim data needed for the self-funded rating process, Swiss Re needed to change the game!  Now, with minimal underwriting information, fully insured groups can acquire an ESL quote.   

Each employer is unique and must determine if self-funding will help them meet their distinctive goals.  A few basic questions may help to gauge their risk appetite: 

  • Do they want to create a tailored plan that meets unique corporate financial needs and enables plan design flexibility?
  • Do they want to gain control over how insurance premiums are spent, improve cash flow, reduce premium taxes and maintain health reserves for corporate investment? 
  • Do they want to leverage the health benefit plan to attract and retain employees?

To aid in the review of this option, our actuaries have developed a proprietary tool enabling a CFO to look at possible outcomes of moving from a fully insured to a self-funded policy.  After obtaining a Swiss Re ESL quote, the employer may use the tool to compare the financial difference between the two programs.  Of course, the final decision remains with the employer but this tool may illustrate some of the advantages and disadvantages. 

Next steps and resources for exploring self-funding:

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