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Self-Funded Health Plans

More flexibility and the opportunity for savings make it critical for Accountable Care Organizations to offer self-funded group health plans.

Creating an Opportunity for Savings

In a traditional insured health plan, rates are fixed for a year and monthly premiums are based on the number of employees enrolled. The insurer collects the premiums and pays the health care claims based on the policy’s benefits. Plan participants are responsible for deductibles and co-payments.

In a self-funded plan, fixed costs such as administrative fees are billed monthly based on plan enrollment but the employer pays claim costs as they are incurred. Stop loss insurance reimbursements are made if claim costs exceed the catastrophic claim levels in the policy, making the total equal to fixed costs plus claims expenses less any stop loss reimbursements.

Limiting Your Claims Risk

In virtually all self-funded health plans, the employer does not assume 100% of the risk for catastrophic claims. We help employers buy stop loss or excess loss insurance to reimburse the plan for claims that exceed expected levels. When claim costs are below expected levels, the savings remains with the employer and not an insurance company.

Self-funding can provide the flexibility to design a plan that is best suited for your organization and your plan participants. The information gained will help you better manage the risks and future costs of health care.

ACA Self-Funded Plan Marketing Tools

Visit the Self Insured Plans website, ACA's third party administrator partner, to find additional information regarding self-funded plans, including:

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Local Accountability

By banding together under an ACO, groups of hospitals and providers are improving the quality of patient care by accepting responsibility for improved patient outcomes and participating with Medicare in any financial savings.

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Population Health Management

Find the resources and tools your ACO will need to manage population health, share ACO data with the Center for Medicare and Medicaid Services (CMS), improve population health and slow the growth of Medicare expenditures.

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Electronic Health Records

erecordsIn an ACO, at least 50% of the primary care physicians must have Electronic Health Record capabilities. The purpose is to provide for data sharing with the Center for Medicare and Medicaid Services (CMS) and comply with strict adherence to medication protocols. It also helps providers place a greater emphasis on patient screenings.