FREQUENTLY ASKED QUESTIONS ON SELF-FUNDED PLANS

What is a fully insured health plan?
What is a self-funded health plan?
Why do employers self fund their health plans?
With what laws must the self-funded plan comply?
Is self-funding for everybody?
What is excess-risk (or Stop-Loss) coverage?
Do I have to redesign my existing health plan?
What about payroll deductions?
Will my life insurance coverages be affected by self-funding my health plan?
Who will take the place of the insurance company to administer the plan?
What are the advantages in using a TPA?
Do TPAs do as good a job, or a better job, than insurance companies??
Why should I self-fund my health plan?

What are the advantages in using a TPA?

The principal business of a TPA is administration of self-funded benefit plans. Insurance companies mainly insure--that's their business. TPAs don't insure - they deal with self-funding. They're the experts. The bywords of a TPA are flexibility and service. TPAs are entrepreneurs responding to each client's needs, no matter how small the client. Some of the services offered by TPAs include:

• Plan design consulting
• Cafeteria plan design
• Contracting for excess-risk coverage
• Claims administration
• Contracting with utilization review/managed care companies
• Preparing government forms 5500 series
• HIPAA compliance
• PPO network maintenance
• Enrollment services
• Writing and printing of SPD booklets and plan documents
• Employee communication programs
• COBRA compliance
• Client reports
• Recordkeeping

Return to Top