This article is part of our Small Business Corner series, which is designed to address challenges and considerations regularly faced by owners of small- to mid-sized businesses. Check out past Small Business Corner articles at efq.hongkonghexin.com/small-business-corner.
What About A ‘Partially’ Self-Insured Health Plan?
If you associate self-insured health plans with big, 只有几千名员工的上市公司, you might be surprised to learn that small- to mid-sized businesses can benefit from specific types of self-insured plans too.
The traditional model in self-insured health insurance is that the employer pays health care costs up to a certain dollar amount for each employee before a stop-loss insurance policy kicks in to pay the rest. A stop-loss policy is typically designed to pay claims that exceed a specific amount of catastrophic medical claims for particular employees. 例如, a company might pay for all medical bills up to $100,每名员工000, and then the stop-loss insurance would pay on any employee medical bills that exceed that $100,000.
Learn about other Employee Benefit Health Plan Opportunities for your Business. Listen to this episode of 意图’s award-winning 播客, 不适合在意图电台播放.
如你所见, 用传统的模型, self-insurance only makes sense if you could spread out the risk of those few employees who might have substantial claims throughout the rest of the employees. For that to work, you need many employees – 200 employees is a good number. 有一个自我保险计划, an employer chooses to pay for individual health claims out-of-pocket instead of a monthly fixed premium to a health insurance carrier. This can actually allow employers to save a lot of money on insurance premiums and costs, but it also exposes the company to more risk if there are more claims to pay than expected. Employees still pay the employer for insurance premiums – that money is just going to the employer as the actual insurer. The strategy is to make enough money in employer-side premium savings, 以及雇员支付的保费金额, 用来支付医疗费用.
While some employers use the traditional self-insured option described above, there are now options for smaller companies to reap the benefits of self-insured plans at a much lower risk – one of which is a partially self-insured health plan.
有部分自我保险计划, your company obtains traditional insurance coverage (what you have in place right now, 例如). Your company then raises the deductible on the group health insurance plan to the maximum amount they can. 例如, 如果你有2美元,现在你的计划可以扣除1000美元, 你可以把它提高到7美元,000年的免赔额. 然后公司自行投保差额.
它是如何工作的?
员工负责前2美元,000 of health care costs; then the company pays for the additional $5,如有需要，可扣除的金额. The insurance the company would pay anything over that $7,000 for each employee as normal. 这种风险要小得多, 每个员工的, 比典型的, 完全自我保险安排-只需$5,每个员工000美元而不是100美元,000. While the savings are also less, they can still add up!
有利的一面
Oftentimes, companies save a significant amount of money with these plans. With a higher deductible, the overall premium for the insurance is lower. The employee is getting the same sort of deductible they’re used to (in this example, $2,000美元)，并支付相同部分的保险费, and the employer pays less of the premium but assumes some risk.
The truth is, many employees will not even burn through the first $2,000 of the deductible. You know (or can find out) about your company’s overall claims experience, to give you an idea of how many employees might exceed this threshold.
The company then harvests all of the premium savings, 减去他们需要支付的2美元,000元及7元,000. This can give the company valuable cash reserves to put into new machinery or expansions. Or you can invest the money to have it available for high-claim years.
Think of regular insurance like interest – you kind of know what you are getting (or in this case, 支付). Self-insured plans are like stocks – you will have some really good years, 有些年份真的很糟糕，中间还有很多年份.
不利的一面
最大的问题是风险. If there are high claims, your company has to foot the bill until its portion is fulfilled. Think of regular insurance like interest – you kind of know what you are getting (or in this case, 支付). Self-insured plans are like stocks – you will have some really good years, 有些年份真的很糟糕，中间还有很多年份. Overall, though, you tend to win in the long run. After all, insurance companies that take on the same risk are fine!
Keep in mind that these self-insured plans (partial or traditional) are not plans you can just buy off the shelf. Each plan must be customized and often needs a third-party administrator. Companies considering this option also need to perform due diligence and a cost/benefit analysis and should consider hiring professionals to help. 此外, with both fully self-insured plans and partially self-insured plans, companies must file annual 1095s for employees (if they are not already).
While it does take some time and effort to put the partially self-insured option into place, 你的生意肯定会受益. If you have questions, we are here to help guide you to a decision that best suits your company. 安全的赌博软件协会的成员 & 今天的团队.
By 丽莎·比默，注册会计师 (新费城办事处)