What is Self-Funding

Large group insurance plans are experience rated. The premium is based upon claims incurred in the past and claims that are expected. In addition to the experience rated portion of the premium, the insurance company adds reserves and retention.

The retention and reserve portion are usually significantly higher than a group would pay for quality third party administration… and the reserves would accumulate to the Plan rather than to the insurance company.

Self funding is when a Plan takes the money it would have paid to an insurance company, puts it into a trust, and uses that money to pay claims. The money sits in the trust, accumulating interest (which adds to the Plan’s reserves) until needed to pay incurred claims. With National Health Plan’s claims processing, claims are paid promptly and efficiently, with no waste, and with discounted provider networks, the plan pays less than the posted provider rates

More importantly, the Plan is not bound to the insurance packages that the companies offer, with mandated benefits and possible support for community rated policies. A self funded plan has the ability, and the freedom, to design a plan that fits its needs… no more and no less.

Most companies that are in a position to take advantage of self funding are not in a position to administer their own benefit plans, arrange for provider networks, or comply with the myriad laws by which a Plan needs to abide. That’s where National Health Plan can help. We have the staff and the experience – and the networks – to ensure that your plan is administered efficiently and properly – and with the personal attention to your participants that they just don’t get from insurance companies.

For clients that have the need, stop-loss insurance can be obtained. This protects the Plan for large claims, on an individual or aggregate basis. With a stop-loss policy in place, the Plan’s exposure is limited, but its self funded status is not.

Administrative Services

NHP can offer all of the following to your Medical, Hospital, Dental or Prescription Plans:
Multiple Plan Design Options
Medical Management including Disease, Case & Claims Management
Detailed Reports
ID Cards
Local/National Networks in all Provider Areas
Benefit Booklets including Plan Documents
Complete Plan Administration, including Claims Processing
Toll-Free Customer Service
Eligibility Services
Stop-loss Coordination

Service Partners

National Health Plan works with a broad array of local and national provider networks, case management and review companies, prescription benefit administrators, stop loss carriers and Managing General Underwriters. We offer one stop shopping for self funding – and a track record of over 35 years of savings for satisfied customers.

National Health Plan Corp. is not a law firm and no opinion, suggestion, or recommendation of the firm or its employees shall constitute legal advice. Clients are advised to consult with their own attorney for a determination of their legal rights, responsibilities and liabilities, including the interpretation of any statute or regulation, or its application to a client’s business activities.