Blog | self funded health plans

Since the ACA was enacted eight years ago, many employers are re-examining employee benefits in an effort to manage costs, navigate changing regulations, and expand their plan options. Self-funded plans are one way that's happening.

In 2017, the UBA Health Plan survey revealed that self-funded plans have increased by 12.8% in the past year overall, and just less than two-thirds of all large employers’ plans are self-funded.

Here are six of the reasons why employers are opting for self-funded plans:

Tax information Employers with self-insured health plans are facing new Section 6055 regulations regarding the reporting of minimum essential coverage. The proposed regulation requires self-insured employers to report this information to the IRS on either Form 1095-B or in Part III of Form 1095-C, if the coverage is provided by an applicable large employer.

The Patient Protection and Affordable Care Act (ACA) established the Transitional Reinsurance Program to help stabilize premiums in the individual private and public marketplaces. The Transitional Reinsurance Fee (TRF) applies to fully insured and self-funded major medical plans for 2014, 2015, and 2016, regardless of the policy or plan year. Insurers of fully insured major medical plans and sponsors of self-funded major medical plans are responsible for filing and submitting contributions for the Transitional Reinsurance Program.

The Key to Reducing Health Care Costs -- Have We Found It? Self-funding is a very hot topic these days for a number of reasons. For small group employers offering a self-funded plan this means they can charge a composite premium rate based on the employee population versus the community rates that are based on each individual enrollee’s age. For all employer sizes this also means that they are not subject to all of the taxes under the Patient Protection and Affordable Care Act (PPACA), which alone can translate into a savings of 3% to 4% of their premiums.

CTA 2014 Benchmarking Survey By Carol Taylor, Employee Benefit Advisor
D&S Agency, a UBA Partner Firm

131723011 By Linda Rowings
Chief Compliance Officer, UBA

140052962 By Elizabeth Kay
Compliance and Retention Analyst
AEIS, a UBA Partner Firm

122493524 By Carol Taylor, Employee Benefit Advisor
D&S Agency, A UBA Partner Firm

178736463 A Summary of Benefits and Coverage (SBC) must contain:

78780375 The Equal Employment Opportunity Commission (EEOC) has sued an employer because the penalty it applied for not participating in its wellness program was, in the eyes of the EEOC, so high that participation was not, as a practical matter, “voluntary.” Under EEOC rules, an employer may conduct medical examinations, which includes obtaining medical histories and blood draws, only in limited situations. One of those permitted situations is a voluntary wellness program. Because the program did not qualify as “voluntary,” the questions employees were asked about their health on a health risk assessment, a blood draw, and a range of motion assessment violated the Americans with Disabilities Act (ADA), according to the EEOC’s Complaint.

6 Reasons Self-Funded Plans Are Gaining Popularity

IRS Proposes New Section 6055 Reporting Requirements for Self-Insured Employers

Transitional Reinsurance Fee for Self-funded Group Health Plans

The Key to Reducing Health Care Costs – Have We Found It?

The Story Behind Minimal Changes in Plan Designs and Premium Rates

Determining If Dental and Vision Plans Are “Excepted Benefits”

Navigating Narrow or Focused Provider Networks (Part 2)

Skinny Plans and Minimum Value: Do these plans really pass the test?

What to Include in an SBC

EEOC Files Suit Over Wellness Program