Shift to Self-Funding as a Long-Term Strategy to Control Costs and Improve Employee Experience


The Company

  120 employees
  Group medical plan

The employer pays about 70% of the single premium and about half of the family premium for the base plan; a buy-up option is available.

The Challenges

  The company receives a renewal without any claims data
  Carrier asks for a “no shop number”

The carrier will ask for a “no shop number,” meaning, what will it take to renew the health plan now without going to market? Sometimes that is not offered, and the client asks to shop the market for competitive quotes. Quotes are shared with the current carrier, who will often reduce the renewal depending on market conditions. Meanwhile, many clients tell us that they feel this is a game, a dance done every year, all done with limited claims data to justify the initial rate request.


The Solution

  Worked with Rubicon to evaluate the feasibility of going self-funded

  Explored self-funded options with the client

  Designed a program that will provide transparency and the means to effect change and control costs on a long-term, sustainable basis

With nationwide access to countless vendor-partners, we explored Third Party Administrators (TPA), stop-loss carriers, pharmacy benefit managers (PBM), and networks, both locally and nationally.


The Results

  First-year costs ran at the expected level (flat overall spending from the year prior)

  Second-year costs are evaluated based on actual claims spent with up-to-the-minute transparent claims data

  Predictable long-term control of the company’s second most expensive line item, just behind payroll.

  Employees who are happy and aren’t forced to change carriers every year

  No checking to see if their doctors or pharmacies participate in the new network

 Self-funding turned into a long-term, win-win solution for employees and the company

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