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Self Funded Insurance



According to Kaiser Family Foundation Employer Health Benefits Survey (2020), annual premiums for employer-sponsored family health coverage reached $21,342 in 2020, up 4% from the previous year, with workers on average paying $5,588 toward the cost of their coverage. Bottomline, premiums are going up while health care coverage is going down.


New data show changes in how insurers structure health insurance benefits have made out-of-pocket costs, like balance billing, harder for patient to budget for or predict. A Kaiser Family Foundation analysis found that patients are paying more out-of-pocket, further adding the burden on patients. Cost-sharing reduces premiums (because it saves your health insurance company money) in two ways.


First, you are paying part of the bill, sharing in the cost with your insurance company, they pay less. Secondly, since you are sharing in the cost or part of the bill, it is more likely you will only seek medical care when you really need it.


If you select a health plan with lower cost-sharing (i.e., lower deductibles, copayments, and total out-of-pocket cost when you need medical care), these tend to have higher premiums, whereas health plans with higher cost-sharing tend to have lower premiums.


IT IS TIME FOR A SELF FUNDED INSURANCE PLAN


Regardless of if you are in a managed care plan or going out of network, it is time for a self-funded network. The CarePays network is just that. Your health care services can be purchase or negotiated with the self-funded network. There is no-balance billing.


The CarePays network provides supportive services to validate your eligibility, coverage, and it eliminates any surprised billing. This model has been successfully tested in Canada for years.


The patient makes an appointment, if health benefits or coverage is involved the support team will process your scheduled visit and predefined your coverage and any out-of-pocket costs. If you have a high deductible, the lowering of your health care cost will reduce the monetary value of your deductible, giving you an opportunity to purchase or negotiate for more medical care.


You will have an opportunity to shop for your medical needs, engage in comparative pricing, you can select your doctor based on medical experience, price, gender, etc. The support services team will guide you through this experience, making sure the healthcare is affordable and accessible to all.


The best part, if you are having any coverage issues or if there is any balance billing issues, or you need further healthcare services, you do not have to worry. In most cases, the providers have negotiated with the self-funded platform, your cost will likely reduce because we have our participating provider members under contract. Everything is managed for you, making sure that any issues are resolved before you go to your scheduled appointment. There is no surprise billing.


The supportive services team will provide denial management support services, taking you out of the headache of dealing with billing companies, insurers, waiting on the phone for hours. They eliminate the “Hassel Factor”. You purchase or bid on a treatment, see the doctor, and go home. The supportive team will manage the rest.


If you are interested in learning more, please call 201.255.6239 or email us.

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