How It Works
With The Defend Plans: Simply
Keep claims savings or gift them to an Insurance Company.
The choice really is that simple.
Fully-Insured Coverage
Comprehensive medical coverage
Fixed costs each month
Employer is protected when claims are higher than expected
Insurer keeps surplus when claims are less than expected
Fixed-Cost Self-Funded
Comprehensive medical coverage
Fixed costs each month
Employer is protected when claims are higher than expected
Employer gets surplus when claims are less than expected
The Defend Plans Keep it Simple
Self-funded health plans can be complicated, but they don’t have to be. The Defend Plans are straightforward: nine comprehensive standard PPO plans, strong national networks, a standard contract period, one proven administrator, fair and experienced underwriting. And our Refund Assisters help employers seize the potential for refunds when claims are lower than expected.
We even make it easy to implement Referenced Based Pricing. With our RBP plans, you still have access to physicians and specialists in a traditional PPO network. There is no network for hopsitals, skilled nursing homes, clinics and other facilities, Instead, the plan reimburses these providers a percentage in excess of Medicare. And our nine RBP plans deliver the patient advocacy services of ClaimDOC to minimize balance billing and educate patients and providers before claims are incurred. ClaimDOC is so confident of their ability to prevent balance billing they handle the appeal process as a co-fiduciary.
It all comes together to make The Defend Plans the safe and simple way to transition from fully-insured to self-funded medical coverage.
Advantages and Responsibilities
The opportunity for refunds is the advantage of self-funded plans that gets most of the attention. But there are other benefits as well. For example, self-funded plans are governed by federal law so employers can offer the same plan in all the states in which they do business. And monthly payments are often comparable to those of traditional insurance.
Self-funding does entail some additional responsibilities for employers. They are responsible for paying eligible claims of employees and their dependents. That’s why companies self-funding coverage need to work with a dependable administrator, offer a cost-effective network, and have access to programs that manage risk. All of which the Defend Plans deliver.
This additional responsibility is also why most companies–especially those new to self-funding–use excess-loss coverage to cap their claims exposure. Again, that’s what the Defend Plans deliver with both specific stop-loss coverage (limiting employers’ exposure to claims from any one employee or dependent) and aggregate stop-loss coverage (capping exposure to claims from all of a company’s insureds).
Please see the “What to Know About Self-Funding” flyer on the “Collateral” page for more information.