Resources
Self-Funded Insurance Plans
At Self-Funding Partners, we believe that understanding your options is the first step toward making informed decisions for your company’s well-being. As industry leaders in self-funded insurance plans, we curated a comprehensive list to simplify the terminology surrounding self-funded plans, giving you the knowledge to choose the best fit for your organization. Whether you’re exploring self-funding for the first time or seeking to deepen your understanding, this list should help you navigate the complexities of different plans.
A Minimum Essential Coverage (MEC) health plan is an insurance plan that meets ACA requirements, providing basic health coverage with essential benefits like preventive services, emergency care, and hospitalization, to fulfill the individual mandate and avoid the ACA penalty.
A Minimum Value Plan (MVP) in health insurance is an employer-sponsored plan that meets ACA requirements by covering at least 60% of the total allowed benefits cost, offering essential health benefits with employees sharing the remaining 40% through cost-sharing methods.
A Health Savings Account is a tax-advantaged savings account that individuals in the United States can use to save money specifically for medical expenses. HSAs are not self-funded plans on their own. They are designed to be used in conjunction with a high-deductible health insurance plan.
Point of Service (POS) health insurance is a hybrid managed care plan combining HMO and PPO features. It requires choosing a primary care physician (PCP) and mainly using in-network providers like HMOs. However, members can also seek out-of-network care, albeit at higher costs, without needing referrals like PPOs.
Reference-Based Pricing (RBR) is a healthcare cost-containment strategy where reimbursement rates for medical services are set based on a reference point, such as Medicare rates or a percentage of average costs. It aims to promote cost transparency and control healthcare spending by using predetermined benchmarks for provider payments.
A Preferred Provider Organization (PPO) is a type of health insurance plan that offers a network of healthcare providers at discounted rates for plan members. It allows individuals to choose both in-network and out-of-network providers, giving them more flexibility in their healthcare choices compared to other plans.
A Health Maintenance Organization (HMO) is a type of managed care health insurance plan that requires members to choose a primary care physician (PCP) and receive most healthcare services through in-network providers. Referrals from the PCP are usually needed for specialist visits, emphasizing cost-effective and coordinated care within the network.
A Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) is an employer-funded health coverage subsidy plan specifically tailored for companies with less than 50 full-time employees. Employees can receive tax-free reimbursements from their employer while employers are given a tax-deductible benefit for providing the reimbursement.
An Individual Coverage Health Reimbursement Arrangement (ICHRA) allows employers to reimburse employees for part or all of the premiums they pay for health insurance plans that the employees acquire on their own in the
A True Self-Funded Insurance Plan is when a company forgoes any Stop Loss mitigation and assumes 100% of the risk. This approach is uncommon and typically only happens for Rx plans. Contact us today to learn more.
