Risk & Business Magazine Atlas Insurance Risk & Business Magazine Fall 2017 | Page 7

PRODUCT
RECALL
HEALTH
CARE
Self-Funded
Health Care:
BY: VIVIAN HAITSUKA
ATLAS INSURANCE
BY: MICHAEL MADIX
ATLAS INSURANCE
R
ecognizing the increased
popularity of self-funded health
care insurance across the
United States, Atlas Insurance
began offering informational
seminars to educate Hawaii employers
about their pluses and minuses. If these
seminars are any indication of the current
market, interest in self-funded plans is
clearly on the rise. After all, insurance
companies are in business to turn a profit,
and if you’re like most businesses, health
care costs are a huge expense that keeps
rising. Therefore, you may want to consider
a change to a self-funded plan.
This type of major change in health care
funding would require a proper feasibility
study and implementation planning.
With self funding, you are essentially
betting that you can manage your plan
more inexpensively through a third-party
administrator (TPA) than you could through
a traditional carrier.
The team at Atlas works with employers
to determine whether self funding is a
feasible option, and if so, which funding
arrangement would be the best fit for
your company. Our role is to assess the
performance of our self-funding vendors,
and based on experience, business model
and complementary business relationships,
make the best recommendation for each
individual client.
An important basic consideration is
company size. For most employers, the
self-funding option only makes sense if the
risk is spread among a minimum of 800
employees on the assumption that a greater
number of healthy participants will offset
those requiring more expensive care. Here
are some of the factors that would enter into
this type of analysis:
1) Third-Party Administration – Analysis
of TPAs operating in Hawaii including
evaluation of their network, fees and case
management resources.
Does It Make Sense for Your Business?
2) Provider network – Analysis of the
number and range of available network
providers including coverage for employees
or family members on the mainland.
3) Management efficiency – Assessment of
the overall performance of the administrator
including its level of training, expertise,
utilization history and staffing structure.
4) Case management system – Review of the
methods used to track large or complex cases
including specific roles of nurse-managers
and other medical support personnel.
5) Pharmacy benefits – Analysis of overall
program quality including relationships
with third-party pharmacy management
companies, formularies used for prescription
medications and costs for claims processing.
6) COBRA administration – Availability,
costs, and management of a CO BRA plan for
former employees.
7) Stop-loss protection – Assessment
of each client’s tolerance for risk and
recommendations for specific (individual
catastrophic illness) and aggregate (overall
plan) levels of stop-loss coverage.
8) Compliance – Assurance that clients
remain compliant with federal and state laws.
9) Wellness programs – Robustness and
maturity of preventive care programs such as
inclusion of informational seminars and cost
incentives to maintain a healthy lifestyle.
This final element—the plan’s attention to
wellness programs—is absolutely essential
to the success of your self-funded plan.
Wellness is the risk management strategy
for mitigating risk associated with your
health plan. If you have employees that
don’t regularly see their doctor or dentist,
they could be postponing needed care. By
not taking preventive measures, employees
may be seeking treatment only when
their medical problems become serious
and more expensive for the employer who
is self-funding. Additionally, employees
who are unfamiliar with the tools and
resources provided by their health plan may
inadvertently use more expensive services.
Atlas works with our clients to ensure
that the right incentives are in place to
motivate employees to maintain a healthy
lifestyle, assume responsibility as engaged
health care consumers, effectively manage
ongoing chronic health conditions, and
properly screen for potential serious health
conditions.
The overall goal is to keep employees as
healthy as possible for the long term, both
for their own welfare and to minimize
health care expenses for their employer.
Atlas Benefit Consulting also works with
our clients to ensure that their program is
manageable, relevant and in compliance
with federal and state laws.
Speak to your Atlas representative or attend
one of the agency’s informational sessions
to learn whether self-funding options make
sense for your business. +
As the Wellness and Communications
Consultant for Atlas Benefit Consulting, Vivian
Haitsuka joined Atlas in 2009 when Bank of
Hawaii Insurance Services was acquired by
Atlas Insurance Agency. Vivian has over 20 years
of experience in Employee Benefits, working
with medium and large clients in non-profit,
education, automobile dealerships, hospitality
and insurance. As a Benefits Consultant, Vivian
is responsible for design and consultation of
best-in-class wellness and employee engagement
strategies for Atlas’ full-service clients.
Michael Madix joined Atlas Insurance Agency
in 2016 as a Senior Benefit Consultant. He
brings with him over 14 years of experience as
a group health insurance underwriter. Prior
to joining Atlas Insurance Agency, Michael
was the Senior Underwriting Manager
at Family Health Hawaii. Michael has
experience in working with small, mid-size
and large businesses in both fully-insured and
self-funded arrangements. He leads the self-
insured program for Atlas Benefit Consulting.
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