Partial Self-Funding: “Bending The Healthcare Trend”

The year is 2009, my good friend Mark Gaunya, of Borislow Insurance co. writes the book “Bend The Healthcare Trend“. In 2017 the second edition is printed. Why is this subject so important? Believe it or not, companies from 5 – 5000 employees can “Bend The Healthcare Trend”. How you ask? Partial self-funding.  My clients have benefitted from partial self-funded plans for the last 25 years. Aetna and UHC (United Healthcare) now offer these plans. Other plans are out there that use National PPO networks, combined with an administrator and competitive stop loss and  reinsurance put you in the driver’s seat, not the insurance company.  

Read on I will provide some examples, first a brief review of the benefits of this funding method for employers and their human capitol, their employees. One benefit, groups under 50 receive composite rates for all tiers. All plans come with Telehealth and Nurse assistance programs, separate pharmacy vendors that watch every prescription that your employees fill to make certain the employee and your plan is receiving the lowest price out there.  One of the entities that I work with brought out a new plan this year. The plan is a zero deductible and zero copays.  The real benefit of this plan, “Call the Nurse” you will be directed to the best Guided Network (yes a National PPO network) providers in your area for the most appropriate care when you need it the most. The goal of this plan is to control costs and provide your employees with providers that practice “Evidence -Based Medicine”. Evidence Based Medicine means that the course of treatment you receive has been scientifically tested, reviewed by medical peers, and confirmed to be safe and effective for a given condition. There is always risk involved in medical treatment, but with Evidence-Based Medicine, experience, data and the power of numbers guide best practices.

The following example is one of the most rewarding ones that I have brought to a client in the last 25 years. Three partners at this client, 65 employees on their health plan. The group had  received a 31% increase, (this was 3 years ago) one of the partners refers me into the group. The managing partner had a 15 year relationship with his benefits consultant. The bottom line, quoted the group, premiums were the same as their current premiums, good bye 31% renewal.  That saved them $95,0000. Claims savings that first year were $63,000. That equals a total savings of $158,000.

There is a lot of misinformation out there on these types of plans, do not listen do not believe it, investigate this type of funding for your company. Hopefully, this blog does not come across as a big sales story, my goal is to disrupt your thinking and the status quo out there and to “Bend The Healthcare Trend”.


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Joel White

Horizon Government Affairs

Horizon Government Affairs was founded in 2007 by Joel White, a veteran of Capitol Hill who served as staff director for the Ways and Means Health Subcommittee. Since then, we have built an impressive bipartisan team of thought leaders and problem solvers with decades of experience in securing wins for our clients.
As experts in our field, we help our clients pass legislation, change regulations, testify to Congress, and drive the conversation on emerging issues. We do this through creative policy development, data driven-insights, innovative issue campaigns and advocacy strategies and through coalitions of allies we have cultivated for years.
Horizon Government Affairs is trusted by lawmakers, influencers and clients alike because we lead with integrity and get it right the first time.

Jennifer Berman, Esq.

Compliance Officer

Jen Berman is an employee benefits attorney. In that capacity, Jen routinely negotiates service contracts and drafts employee benefit plans, summary plan descriptions and employee communications. She also reviews client benefit programs for compliance with the Internal Revenue Code, ERISA, HIPAA, COBRA, ACA, wellness plan rules and other applicable statutes.

Since the passage of the Affordable Care Act in 2010, Jen has also become an “ACA compliance educator.” She is a leader in analyzing health care reform developments and frequently serves as a speaker and commentator on a wide variety of health care reform and employee benefits issues.

In addition to serving as CEO of MZQ Consulting, LLC, Jen is also a member of Holder Law Group LLC. Prior to joining Holder Law, Jen practiced at Venable LLP as part of their Employee Benefits and Executive Compensation practice group. Jen graduated cum laude from the University of Pennsylvania Law School, where she was Editor-in-Chief of the University of Pennsylvania Journal of Labor and Employment Law. Jen also completed her undergraduate studies at the University of Pennsylvania, graduating magna cum laude with a Bachelor’s of Arts in Political Science. She is an avid lover of textile arts, frequently wearing stunning pieces she has hand-crafted herself.

Alan Schulman

Alan Schulman
Alan Schulman is President of Insurance Benefits and Advisors. IBAA is a leading diversified comprehensive insurance brokerage and advisory practice specializing in life insurance, health and welfare services, retirement plan consulting, property & casualty insurance, and wealth management. Alan started his career in 1980 as a Certified Financial Planner and transitioned into the insurance industry in 1988 to work with company owners on their employee benefits. Alan is licensed in health, life, long term care and all lines of business insurance, and assists top executives in creating and preserving wealth and a secure retirement. Alan is past President of The Greater Washington National Association of Health Underwriters (GWAHU) and is past President of the Maryland Association of Health Underwriters (MAHU). He is a lifetime member of the Leading Producers Round Table of the National Association of Health Underwriters (NAHU), and was appointed in 2010 to sit on the Board of Directors for NAHU’s political action committee, the Healthcare Underwriters Political Action Committee (HUPAC). On March 6th, 2014 Alan testified before the U.S. Congressional Small Business Committee, representing NAHU and his client, on the impact of the Patient Protection and Affordable Care Act (PPACA, commonly referred to as “Obama Care”), on small and medium size businesses. Alan currently serves on the Joint Legislative Task Force in Maryland, and meets with legislators in Annapolis to assist in the creation of laws that positively affect the cost of health insurance. He was an original member of the MD and DC Health Insurance Exchange Advisory Committees. Passionate about serving his community, Alan is a member of the Maryland Nonprofits Association and Maryland Association of Community Services (MACS). In 2014, he served on the Board of Directors for Hearts & Homes for Youth, a non-profit organization serving young survivors of neglect and abuse. Alan is a board member with JCRC. He is also an active member of the Metro Bethesda Rotary Club. Alan and his wife Robin have been married for 35 years and have resided in Olney Maryland for 33 years, where they raised their two daughters.

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