Definition of a self-funded plan
According to the Self-Insurance Institute of America, Inc., a self-funded group health plan is one in which the employer assumes the risk for providing health care benefits to its employees. Instead of paying a fixed premium to an insurance carrier, self-funded employers pay employee health care claims out of their own pockets as the claims are incurred.
According to the 2006 Kaiser Family Foundation Employer Health Benefits Survey, more than half (55 percent) of U.S. companies partially or completely self-fund their health care plans.
Employers with the financial and administrative means to pursue self-funding can succeed no matter what their size. We have seen employers with 25-30 employees do very well.
Benefits of self-funded plans
- Elimination of many state imposed regulations and restrictions. Self-funded plans are governed by ERISA (Employee Retirement Income Security Act of 1974); and as such are subject to federal regulations only; including ERISA, COBRA and HIPAA laws.
- More control over the types of benefits and the levels of coverage.
- Cost savings. Eliminating state premium taxes, overhead and other fees paid to their former insurers.
- Minimizing claims costs through emphasis on preventive medicine and using most cost-effective medical providers.
Thailand as a Medical Destination
Ultimately, a self-funded group health plan is only as good as the quality of healthcare it provides.
Medical costs play a crucial role in Thailand's growing status as a medical destination. According to Health Department figures, more than 150,000 Americans traveled abroad for health care this year.
The reasons are twofold: cost and the quality of care.
As for cost, according to "Patients Without Borders: Everybody's Guide to Afford¬able, World-Class Medical Tourism," an authoritative book by Josef Woodman, overseas care can trim anywhere from 60 to 80 percent-sometimes even more-from the cost of major treatments,
Thailand is attractive to medical tourists because of its first-rate care, doctors, hospitals, clinics and health facilities that rival the best in the U.S. or Europe.
Thailand’s compassionate and caring treatment of patients is renowned. There is also a much stronger emphasis in diagnosis and preventive medicine than generally found in Western Countries. This is why Thailand would be an excellent center to help members manage their health conditions and employers lower healthcare costs, reduce absenteeism and increase productivity.
Keys to Success
• Customize plan to your specific needs:
- Perform claims and demographic analyses. Understanding volume and nature of employee health claims is essential.
- Understand cash flow. These plans work well for companies with strong cash flow or reserves..
- Determine benefits coverage preferences. Examples of issues that must be decided include employee eligibility for the plan, covered benefits and exclusions, employee cost-sharing, policy limits and retiree benefits.
- Evaluate stop-loss options. Most self-funded employers purchase stop-loss insurance that provides protection against costly claims.
- Assess administrative options. Employers also need to assess their administrative strengths and weaknesses and decide whether to administer the plan in-house or through a third party.
- Create a plan for monitoring. Employers need to decide at the outset how they will monitor performance of the self-funded plan.
• Seamless facilitation by specialist in Thai medical travel.
• Utilize the most qualified and dependable medical providers in Thailand.
Integrated Team Approach
We have assembled the first team of its kind integrating the benefits of Thailand medical travel while assisting in evaluating, establishing and administering your self-funded care plan.
The Team
Stop-Loss Brokerage, Inc.
ERISA –based self-funded plan designer for over 25 years assisting in customizing the self-funded healthcare plan. Facilitates plan enrollment, ongoing client and member services.
Meritain Health
The country’s largest independent plan administer for self-funded health plans and a leading national provider of Consumer-Directed Health Plans (CDHPs).
Thailand Medical Travel & Tourism
A full-service medical travel agency assisting international patients traveling to Thailand for over 10 years, offering highly personalized services.
Bangkok Hospital & Affiliates
With dedicated hospitals for cancer and heart disease, and over 30 specialized clinics and centers, a leading tertiary care facility providing award-winning, world-class healthcare services.
Our philosophy
Our team is committed to providing our clients with all of the services they expect, as well as the resources to help them manage the long-term costs of their health benefit programs. We understand that by having a focus on current and future healthcare costs, we provide the most value for our clients.
We are the first in the industry to integrate foreign medical service providers in our plan. This provides a profound cost savings opportunity without sacrificing quality. We feel Thailand is unique in this regard due to unparalleled patient care and commitment to healing and preventive medicine.
Recent studies have shown that 70% of healthcare costs can be attributed to lifestyle-related illness and are therefore preventable.
We believe the only way to change the rising trend in healthcare costs is to change the behavior of employees, promote healthier lifestyles, and make them better healthcare consumers.
As the cutting-edge leader in Consumer-Directed Health Care, we provide the education and tools necessary to change consumer healthcare behavior. Our goal is to understand and service individual health care needs, while providing the motivation and programs necessary to achieve healthcare goals.
We also believe that having the size and strength to help clients govern short and long-term cost management programs does not diminish the importance of providing an excellent customer experience to our clients and their employees. To the contrary, we are committed to using our size and strength to offer
our clients and members a personal, intimate and caring experience.
Provider Network Strategies
Customization of a provider network entails consultative analysis based on knowledge of an employer’s organization, location(s), operations and workforce demographics. The outcome of this analysis is the development of network combinations from a pool of more than 270 networks.
Ancillary Programs and Services
Our capabilities include specialized programs and services related to claims that have the capacity for high employer costs. Programs include:
• Subrogation
• Fraud detection
• Kidney care management
• Transplant management
• Specialty provider programs:
> Oncology
> Transplant
> Dialysis
Healthy Merits
Meritain Health captures significant cost savings through Healthy Merits, a total population management program proven to help members manage their health conditions and employers lower healthcare costs, reduce absenteeism and increase productivity.
Wellness
Awareness is the mandatory first step in improving member wellness. Through voluntary on-site screenings, members discover their health risks and conditions. To address these health risks, Healthy Merits targets four essential measures to promote member wellness:
• smoking cessation
• weight management
• improved physical fitness
• preventive medical exams.
Employee Education
Through effective, ongoing education and communication, plan members learn to take maximum advantage of their health benefits. Education promotes consumerism, provides members with an understanding of the true cost of healthcare and empowers them to make healthcare choices based on both quality and cost.
Meritain Health’s educational programs and tools include:
• customized welcome kits
• On-site health fairs
• Lunch-and-learn programs
• Online self-management tools
• Posters and flyers
• Dedicated Service Team
We will assemble an experienced, dedicated service team whose objective is to become an extension of your own human resource team. Their first priority will be to develop a 12-month service plan highlighting milestones and deliverables for the plan year.
Your administration team will include:
• A client relationship manager (CRM)
• Client liaison
• Operations manager
• Claims analysts
• Customer service representatives
• Eligibility Specialists
Plan Administration Features
• Personalized customer service
• Dedicated toll-free number
• Extended service hours
• Web-based self-service
• Flexibility to deliver individualized programs
• Performance guarantees
Next Step
Should you have questions or wish to discuss whether a self-funded health care plan is appropriate for your firm, please contact Keith Johnson, President Stop-Loss Brokerage, Inc. at 1-502-245-1508 or at keithjhns@aol.com.
Team Backgrounds
Stop-Loss Brokerage
A full service brokerage specializing in ERISA-based Self-Funded plan designs for over 25 years. With access
to, and direct underwriting experience with, a large diverse range of TPAs, reinsurance carriers, MCOs, MGUs, and PBMs, Stop-Loss Brokerage has excelled at keeping its clientele in a cutting edge platform, assuring optimum plan performance and high level claims management.
Meritain Health
The Trust of a Strong National Company
At Meritain Health, we have over 20 years of experience serving clients of all sizes. As an Aetna company, we are committed to using our size and strength to offer our clients, and our million plus members, a personal and caring service experience.
Service Excellence
We have a strong belief that through our suite of services, we can help customers improve the health and well-being of their employees - our members. We structure our customer service teams around individual employers. Our dedicated service representatives are trained to
assist employees with all aspects of healthcare consumerism. As the emerging role of consumerism in healthcare continues, we place great emphasis on our members with every opportunity made available to us.
To further our commitment to service, our client relations team works closely with each employer to proactively provide pragmatic advice and insight into the development of cost mitigation plans. Our state of the art informatics tools allow us to provide employers with customized reports and analysis of claim activity, medical utilization and cost trends. As your partner, our goal is to provide you with information and solutions to rising healthcare costs.
Contact:
Thailand Medical Travel & Tourism
According to Kiki Bright, VP of TMTT, "[We are] an intricate detail service-oriented busi-ness requiring personalized service that extends above and beyond hospitality. It requires relationship, attention to detail and significant planning. It isn't enough to know what the client wants. We focus directly on the client's actual needs. Our most important task requires detailed information about the medical background of the prospective patient, as well as an extensive familiarization with Thai doc¬tors, clinics and hospitals. We also pride ourselves in knowing the essential details that make a medical trip as comfortable, safe and secure as possible on emotional and physical levels."
According to President Cherie Bright, in the 11 years since beginning opera¬tions, TMTT has sent count¬less clients to Thailand where it has developed strong working relationships with a network of highly skilled and reputable Thai physicians, clinics and hospitals. "It's extremely important to have a good relationship with medical providers since this allows us to coordinate Initial dialogue between doctors and prospec¬tive patients, the scheduling of medical consultations and--most importantly-setting up examina¬tions and treatments in advance," she says.
Bangkok Hospital & Affiliates
Bangkok Hospital is one of the most technologically sophisticated hospitals in the world today. Bangkok Hospital is also accredited by Joint Commission International, a US-based organization widely seen as the gold standard
for top-level healthcare service providers worldwide. Founded in 1972, Bangkok Hospital has gradually expanded into a state-of-the-art medical campus providing comprehensive care through multidisciplinary teams of highly trained specialists.
With dedicated hospitals for cancer and heart disease, and over 30 specialized clinics and centers, we are a leading tertiary care facility providing award-winning, world-class healthcare services. Setting new standards in patient-focused care, we believe that the personalized attention of our doctors, nurses and staff is essential to providing the highest quality care.
In addition to our medical services, we provide a full range of concierge services for our patients, which include limousine transfer to and from any destination in Bangkok, accommodation arrangements, visa extension services, and even tours for patients’ families. Bangkok Hospital also provides medical evacuation services via a fleet of ground and air transport services.
Wattanosoth Cancer Hospital
Wattanosoth Cancer Hospital is a division of Bangkok Hospital that specializes in cancer treatment. At Bangkok Hospital, we are dedicated to the fight against cancer. That is why we created Wattanosoth Cancer Hospital – Thailand’s first private hospital devoted entirely to the prevention and treatment of cancer.
Wattanosoth Hospital is also the recipient of a special Disease or Condition-Specific Certification by Joint Commission International, for its Breast Cancer Conserving Therapy (BCT) Pathway.
Bangkok Heart Hospital
Bangkok Heart Hospital is a division of Bangkok Hospital that specializes in cardiac care.
Bangkok Heart Hospital is the only dedicated private heart hospital in Thailand and is regarded as one of the finest cardiac facilities in the country. A division of Bangkok Hospital, its state-of-the-art technology and highly trained physicians and support personnel offer advanced and effective treatments in the fight against cardiovascular disease.
Bangkok Heart Hospital is the recipient of a special Disease or Condition-Specific Certification by Joint Commission International, for its Acute Coronary Syndrome and Heart Failure Program.