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Healthcare Costs
March 23, 2022

Successful Small Group Self-funded Programs

2 minute read
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Small groups can benefit from self-funding. There are four essential elements to a successful small group self-funded program.

    1. Experienced Third Party Administrator (TPA). For a small group, a TPA should have experience and staff that can handle the specific issues that may arise because many small groups do not have fully staffed Human Resource and Benefits departments. They must have a well-trained Customer Service staff. In many benefit plans, benefit questions are handled by the TPA’s Customer Service department.

 

    1. Experienced Stop-loss Carrier. Every self-funding plan, and particularly the Small Group Self-Funding plan, should have a stop-loss Often, the smaller group faces difficulty in obtaining sufficient underwriting data because they are coming from an insurer that offers full coverage and do not always have access to their own claims data. Many Stop-loss carriers can offer coverage for smaller groups if they specialize in them or can properly underwrite them.

 

    1. Innovative Cost Containment. Companies like 6 Degrees Health can make a huge impact here. A good cost containment company will provide steering recommendations, reference, value-based reimbursement, or even complex claim management. Great cost containment companies will be able to handle all of these, reducing not only claim costs, but stop-loss premium costs, and even aggregate exposure, which is vital to smaller groups.

 

  1. An Independent-thinking Consultant. It is important to have a consultant, broker, or agent willing to move away from the “traditional” spreadsheet approach. Cost containment does NOT mean raising the deductible or shifting more of the cost to the member. Rather than trying to get points with a large carrier or blue organization, a consultant is more concerned with delivering results to their clients. It stems from the old Zig Ziglar adage, “you can get everything you want if you help enough people.”

Let us know how we can help.  6 Degrees Health has business relationships with over 50 Third Party Administrators as well as a variety of Stop-loss carriers that can meet these criteria, many of which specialize in serving small groups.

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