Empower Your Benefits With a Self-Funded Health Plan
Are you ready to take control of your company's health benefits and maximize cost-efficiency? Setting up a self-funded health plan might be the solution you've been searching for, and we're here to guide you through the basics.
Understanding Self-Funded Health Plans
Self-funded health plans allow companies to tailor their employee benefits while maintaining control over costs. Instead of paying fixed premiums to an insurance carrier, businesses directly fund their employees' healthcare expenses. This approach enables customization, cost transparency, and potential savings.
Why Work With a Third-Party Administrator (TPA)
Enter the role of a Third-Party Administrator (TPA). TPAs, like Summit Administration Services, specialize in managing the intricacies of self-funded health plans. They streamline processes, handle claims efficiently, and administer benefits seamlessly so your HR and leadership teams can stay focused on running the business.
Key Steps to Setting Up a Self-Funded Health Plan
1. Assessment and Consultation
Begin with a thorough assessment of your company's healthcare needs. A qualified consultant can help you understand the risks and benefits associated with self-funding and determine whether it aligns with your financial and strategic goals.
2. Plan Design and Customization
Tailor your health plan to meet the unique needs of your workforce. TPAs work closely with businesses to design plan options, deductibles, copays, and cost-sharing arrangements that align with company goals and employee expectations.
3. Vendor Selection
With your plan parameters in hand, your consultant or broker will solicit bids from the vendors needed to make your plan operate. These vendors can include the TPA, Pharmacy Benefit Manager (PBM), provider network or Reference-Based Pricing (RBP) vendor, case management, utilization review, telemedicine, and wellness providers. These services can be bundled by an insurance carrier or unbundled using an independent TPA so you can choose vendors who are the best fit for your company.
4. Limiting Risk With Stop-Loss Insurance
Your consultant will help limit your risk exposure by selecting Stop-Loss Insurance. Stop-Loss coverage caps the amount of money the plan will pay per member, per month, or per year based on the employer’s risk appetite and the projected costs.
5. Vendor Collaboration
Once selected, your vendors come together as a team to begin working for your plan. Data is shared between them to create a seamless experience for your employees and to support proactive cost and care management.
6. Benefits Administration
The TPA will work closely with your HR, Benefits, and Management staff to become the hub for your plan data. Employees, providers, and vendors will communicate directly with the TPA, much like they would under a fully insured plan—but with more flexibility and transparency for the employer.
Why Choose Summit Administration Services as Your TPA
Summit Administration Services is an independently owned TPA committed to empowering businesses through top-notch health plan management. Here’s why employers choose Summit for self-funded health plans:
Flexibility
Work with any consultant or vendor of your choice. Summit is vendor-agnostic and focused on helping you build the best team for your plan.
Experience
Benefit from Summit's 25+ years of experience managing self-funded health plans across a wide range of industries and group sizes.
Customization
Tailor your plan design, networks, and program partners to fit your unique business requirements and employee population.
Claims Efficiency
Rely on Summit for accurate and efficient claims processing, responsive customer service, and detailed reporting.
Comprehensive Benefits Administration
Benefits Administration and eligibility services are handled for you, ensuring a seamless experience for your HR team and employees.
Transparency and Fee-Only Compensation
Summit is Fee-Only and takes zero commissions or kickbacks from vendors. Recommendations are based on what is best for your plan—not on hidden incentives.
Take the Next Step to Empower Your Benefits
Take the leap toward a more personalized and cost-effective health benefits solution. Contact Summit Administration Services today to explore whether a self-funded health plan is right for your organization.
Call us at 888-690-2020 or email mktgdept@summit-inc.net.
Explore More Self-Funding Insights
For a broader overview of how self-funded health insurance works, visit our page on Self-Funded Health Insurance: What It Is and Why It’s Beneficial for Employers. Tribal governments and enterprises can also explore Empowering Tribal Organizations for details on self-funded workers’ compensation and Native American risk programs.
