Self-Funded Insurance Becomes More Mainstream; Technology All the More Important

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1 Self-Funded Insurance Becomes More Mainstream; Technology All the More Important Thinking of Looking at A Self-Funded Plan? Consider Your Technology Options By Chris Taylor, BeneTrac It used to be that only large organizations could benefit from the economies of scale associated with self-funded insurance plans. Bigger companies tend to have a large risk pool to be able to better predict and price the potential losses from benefits offered to employees over their smaller competitors. However, now self-funded plans are also gaining attention from smaller-business owners as an alternative to traditional carrier-offered plans. In 2008, 55 percent of all firms (plus 89 percent of jumbo 6,000+ firms and 76 percent of large 1,000+ firms) utilized self-funded plans, according to Kaiser Family Foundation s Employer Health Benefits Annual Survey. And those numbers are only growing, according to studies from benefits consulting firm Foster Higgins, which says that today 65 percent of U.S. employers are looking to self-funding for their health plans overall. Finally, the Society of Professional Benefits Administrators says that within the last 12 years, there has been a 6,000 percent increase in employers of all sizes flocking to self-funded plans. Self-funded plans cover about 70 million Americans, according to federal statistics. Perhaps interest in these plans has increased because they offer the potential for the best of both worlds. Employers can sometimes provide more customized healthcare offerings at a greater cost-savings with a self-funded plan than they may be able to by going with a traditional health insurance provider. For some, the changing benefits landscape is necessitating the move, as many organizations are looking to self-funded plans to counteract rising health-insurance costs. Others may see these plans as a possible way to avoid being subject to some of the Healthcare Reform regulations for businesses. For instance, with the passage of the Employer Retirement Income Security Act (ERISA) in 1974, self-funded plans are exempt from many state coverage mandates, including offerings such as acupuncture, port-wine stain therapy, and numerous others. The savings from avoiding these services can go directly to the employer. However, the administration of self-funded plans is one area where corporations are not likely to save. As the entity assuming liability and risk of the health plan in exchange for significant control over its management and funding levels, administrators of self-funded plans must be even more diligent in managing all details of the plans. Not only must they deal with open enrollment, life events, COBRA, termination, and other activities that can occur throughout the employees and plans lifecycle, they must also address aspects of successfully designing and managing the plans themselves, including the following:

2 Underwriting the process of determining what coverage will be provided, and what the employee contributions and monthly premiums will be. Eligibility and coverage tracking. The company needs to ensure that people who are not eligible are not being covered. Examples include individuals no longer with the company, those who have not completed their first 90 days with the company, and those who do not consistently work a certain number of hours per week. Determining adjudication or the payment responsibility of the company Ensuring that plans are funded and billed accurately and not being overpaid. Managing the plans and ensuring they are on target financially. The company needs to make sure that it does not lose money on its self-insured offering. It also needs to ensure that employees are taking advantage of benefits options, while not needlessly overusing them. Communicating about open enrollment, changes in benefits plan offerings, and even day-to-day changes. Some might argue that communication about self-funded plans is even more important than with traditional HMOs or PPOs, since the company is dealing with more stakeholders including employees, the Administrative Services Organization (ASO) that assists with benefits, and the Third Party Administrator (TPA) that pays and manages claims processing. Ensuring integration with payroll and other systems to make sure that deductions for monthly premiums are being taken from paychecks. For administrators of any benefits plan, and especially those of self-funded insurance plans, keeping track of deadlines, requirements, eligibility, employee status, and other factors is a never-ending job that can easily become overwhelming without the proper systems in place. While keeping spreadsheets or a file cabinet of paper documents may have been feasible in the past, with underwriting, eligibility, plan update communications, and even more balls in the air for self-funded plans, those approaches are no longer an option. How can HR managers make sense of all the components of self-funded plans? Technology is critical in managing information. The following are a few of the key benefits that technology should include to manage this endeavor. Eligibility Tracking Everything from who is insured to what is insured, as set forth in plan document, needs to be tracked. HR needs to ensure that the company is accurately paying premiums and is not paying for individuals or services that are not eligible. Technology should automatically manage and calculate eligibility and effective dates for new hires, life events, and open enrollment according to the company's unique rules. A truly capable enrollment engine will evaluate each enrollment activity and apply any necessary combination of rules, messages, prompts, and options specifically designed to meet the exact eligibility requirements desired. HR Managers

3 should not have to modify their eligibility rules to accommodate the software. Self-service Instead of creating forms, passing out paper, collecting it, entering the information, and filing paperwork, HR professionals should rely on technology to administer that process with self-service functionality. Employee access should be a natural extension, given the wide access to computers at home and at work (70 percent of the population has home Internet access) and the time- and cost-saving possibilities. Enabling employees to enroll themselves saves administrative time and money and increases satisfaction. Employees have a vested interest in the plan, greater interest in their own healthcare decisions, and increased accountability when they personally manage the details of their benefits plans online. If an employer has a largely healthy employee population, encourages employees to be smart consumers of health care, and endorses wellness among workers, the employer can reduce claims and premiums. Additionally, the company can benefit from the huge administrative time savings that comes with having employees manage information themselves. Bill reconciliation HR and the corporation need to have confidence that they are paying the correct fees for benefits services rendered for employees. Technology should provide the ability to easily audit bills, to make sure all charges agree with the data in the system. Technology can be used to help ensure the accuracy of medical service invoices. Automated billing reconciliation processes can help companies to save time and money through simpler reconciliation processes and by finding potential overpayment errors that can be that can then be charged back to medical providers. These processes can also assist in the timely delivery of employee enrollments by quickly revealing to HR, at a glance, who has not yet enrolled in insurance plans. Timely confirmation of eligibility can help to ensure that employees are covered before they need to go for care. Communication Tools With all of the changes and updates in healthcare plans and details surrounding them, HR needs to be able to easily and accurately communicate this information to employees in a timely way using a trackable method. Technology should offer the flexibility to communicate with employees on a number of levels and to apply specific filter criteria to target messages. It can be used to educate employees on offerings, simplify administration, ensure employees are meeting deadlines and are aware of time limits for plans, Reporting One of biggest benefits of self-funded plans is that employers can be more creative in their health insurance offerings, and a strong

4 reporting capability can help tailor a company s plan. If a company wants to customize its benefits to include $7 co-pays or 100 percent inclusion of vision for its population, it can do so to suit its needs. Employers have access to underlying claims data that offers insight into how employees are using health plans. Having access to that information helps employers gain a clearer picture of the underlying costs. And, based on the data, an employer may decide to install a wellness or smoking cessation program, or target benefits offerings that will specifically address conditions affecting employees. Reporting should provide the ability to drill down into aspects of coverage to help employers make decisions about everything from the number and length of hospitalizations, to frequency of emergency room visits, outpatient visits, and pharmacy usage. In addition to offering this ability to drill down, software should also offer insight into big-picture views to help enhance decision-making. Valuable benefits management technology should provide a number of options, from standard industry reports to custom analysis, displayed in a variety of formats, including Adobe PDF, Microsoft Excel, and Interactive HTML. HR should be able to point and click on data to create analyses that will empower it in strategic planning. Information is power. HR needs to have ownership of data and the ability to report on it, in order to make the best recommendations on self-funded plans. Integration with other systems Especially important to HR in the initial rollout, benefits management software should provide the flexibility to import data from multiple formats Excel spreadsheets, databases, and paper documents, for instance to accommodate the needs of organizations that have relied on less automated processes in the past. It should also offer the ability to interface with HRIM, payroll, and other systems and data. Benefits management software should be able to capitalize on information already in these systems, as well as ensure that information updated or changed in one system is also reflected in another to prevent errors. History A good benefits management systems will help a company ensure legal compliance through an electronic paper trail of employees actions. For instance, some systems can provide proof that an employee received notice of insurance options when he or she initially logged in and was provided with access to the plan, and proof of response when the employee made a coverage election or decided to forgo coverage. Most insurance companies do not provide this level of detail, but it is becoming a growing necessity as healthcare reform requirements emerge. Especially for companies choosing to manage their own self-funded plans, this is an important feature to have.

5 Electronic Data Interchange (EDI) for data communication As mentioned earlier, those companies offering self-funded plans have an even greater need to ensure the accuracy of information that is exchanged between parties, because they are often working with a larger number of entities such as TPAs, ASOs, etc., and they are ultimately responsible for the performance of the plans. Benefits management can be viewed as the central hub the technology that houses the plan and is used for communication among the employer, TPA, and others. Connectivity should be judged not only by the number of providers with which the software has relationships, but by the type of connection that it enables. Many providers enable transmission of a generic ANSI 834 file, which may or may not be accepted by the carrier, TPA, or ASO, a factor often influenced by the size of the group. Managers should look for providers that offer clean, validated transfers ensuring the eligibility of the transaction customized to each provider s needs to avoid issues. Technology Management Options In assessing each of these details, HR managers need to look closely at what is being offered. Some providers promise full self-service that ends up being a confusing or disjointed experience for the employee, and is in fact not very useful. Others may offer electronic transfers of information to ASO, TPAs, and others that are not necessarily in the format in which it s needed, resulting in headaches down the line. Varying degrees exist for each of these features. In some cases, the company may be required to build and support functionality, requiring a greater involvement in managing the technology versus the processes. HR needs to be proactive and assertive; ask specific, targeted questions; walk through the proposed solution itself; and talk with customers currently using the technology before making a decision. While self-funded plans do require greater access to information and a higher level of involvement from management, the benefits that they can offer often outweigh the risks. Having access to information and technology to manage it all is essential to success of the plan for businesses. Chris Taylor is with BeneTrac, a Paychex company and provider of powerful, webbased electronic enrollment and employee benefits administration software online at He can be reached at ctaylor@benetrac.com

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