Self-Insured Plans - Scott & White Health Plan

TPA Services For Self-Insured Plans

We manage your health care dollars as carefully as we do our own.

We know how important it is to help employers overcome one of today's toughest business challenges - managing health care benefits. As a third-party administrator (TPA) of self-insured plans, Scott & White Health Plan TPA Services can do this for your company. We can help you provide quality employee benefits and improve participant health, while containing the impact of health care costs.

As an alternative to traditional health coverage, a self-insured plan allows your company the opportunity to finance your group's health plan. By choosing Scott & White Health Plan TPA Services, you can focus on achieving your business goals while we manage your company's medical benefits. Our experienced staff provides the support you need to control costs while making certain your employees receive the best coverage possible. By being self-insured through Scott & White Health Plan TPA Services, you can expect:

Competitive administrative fees
Elimination of premium tax
An extensive state and national network of physicians and hospitals
Plan control and design flexibility
Detailed reports about expenditures
Accurate and prompt claims payment

What Does It Mean To Be Self-Insured?

Being self-insured, also known as self-funded, means your company assumes the financial risk of providing health care benefits to employees by paying claims as they are incurred. In essence, your company acts in place of an insurance company. As an employer your responsibilities include:

Paying for employee medical costs as they incur instead of paying a premium
Evaluating the purchase of stop-loss insurance to protect from catastrophic losses
Contracting with a third-party administrator to manage benefits
Complying with the Employee Retirement Income Security Act (ERISA) fiduciary obligations

Usually, a third-party administrator - such as Scott & White Health Plan TPA Services - is hired to administer claims and provide many other services such as:

Plan design
Claims management
Utilization review
Case management
Disease management
Prescription drug card programs
PPO networks
Stop-loss coverage administration

How Stop-Loss Protection Can Protect You

Though not mandatory, stop-loss protection gives self-insured employers peace of mind. While being self-insured allows your company to budget for routine, anticipated claims, stop-loss protection covers your group against catastrophic, unexpected claims. By purchasing this kind of reinsurance - which Scott & White Health Plan TPA Services can arrange - your financial exposure is limited, and you are shielded against predicted and unpredicted health care costs.

Furthermore, stop-loss protects your company when an individual or your entire group exceeds the predetermined amount. There are two points at which stop-loss protection takes effect:

Specific attachment point - cost of one claim or total claims for one person
Aggregate attachment point - total claims of the whole group

Is A Self-Insured Plan Right For You?

If you choose a self-insured plan, your company assumes the risk of paying health care claim costs and must have the financial resources to meet this obligation. Being self-insured is typically recommended for larger employers that have more than 150 employees. Traditional, fully insured health plans operate with premiums. These are referred to as "fixed costs", and no matter how many claims are incurred or not incurred, an employer will pay the same monthly costs for a given plan year. With a self-insured plan, claims are paid as they are incurred.

Compare For Yourself

The following chart outlines the differences between a self-insured plan and a more traditional, fully insured plan. Compare the two to help you understand if being self-insured through Scott & White Health Plan TPA Services is right for your company.

Self-Insured	Fully Insured
Employer retains responsibility for plan decisions.	Carrier retains responsibility for plan decisions.
Legal actions are directed to employer.	Legal actions are directed to carrier.
Employer is accountable for plan expenses as they incur.	Carrier is accountable for plan expenses.
Employer is responsible for providing administrative services.	Carrier is responsible for insurance and administrative services.
Employer receives direct savings from management of care.	Carrier retains the risk, including any underwriting profits or losses.

How Being Self-Insured Can Benefit Your Company

While there are risks, being self-insured provides your company with a number of advantages:

Cost Savings

State premium taxes do not apply to a self-insured plan.
Potential investment earnings from claim reserves are available to fund plan expenses.
Freedom from costly state-mandated benefits.
Plan costs are based on your group's own claims experience, not pooled with any other groups.
Cost of administration is typically lower than with a fully insured plan.

Cash Flow Gains

You are able to realize cash flow gains from holding claim reserves.

Greater Control

You can develop a plan of benefits tailored to suit your employees' needs.
You gain complete control and knowledge of where and how plan costs are allocated.
Real-time management of cash flow is available through online cost reporting and accounting.

What's Different About Our Approach?

It's Not All About Paying Claims

As your third-party administrator, Scott & White Health Plan TPA Services does much more than just process your claims. We provide professional, experienced account representatives who maintain your company's benefits program so you can focus on achieving your business goals. We offer an administrative support staff that will assist you in setting up a self-insured plan that's right for your company.

We Go Above And Beyond

Uniquely, Scott & White Health Plan is a 501c(4) not-for-profit corporation. Because we have no shareholders to satisfy, taking care of your business is our business. We go the extra mile to look out for your bottom line and make certain that you and your employees' needs are met. Scott & White Health Plan TPA Services includes:

Personal Support

Provide you with more control by personally working with you and your employees
Assist in the design of your customized benefit program, Administrative Service Agreement and Summary Plan Description
Advise you on underwriting issues and cost projections
Handle your membership enrollment and eligibility

Finance And Accounting

Assist you with banking arrangements such as setting up a separate account in which to fund claims
Adjudicate and pay your claims
Coordinate your billing including administration, COBRA, HIPAA, ancillary products and reinsurance

Comprehensive Reporting Package

Provide you with more detailed information about health care expenditures with daily, monthly, quarterly and ad hoc reports
Enable you to manage cash flow in real-time with online cost reporting and accounting

Customer Service

Assist you in navigating our network of physicians, specialists, hospitals and pharmacies, which include the Scott & White Clinics and Hospitals
MyHealthMedia™, a health and wellness program
Offer your group HealthConnect, a 24-hour nurse advice line

Optional Benefits

Administer dental, short- and long-term disability¹, group term life insurance¹, voluntary life¹ and supplemental income policies for cancer, hospital confinement and medical-surgical expense²
Oversee your pharmacy services with Prescription Benefit Management
Provide consumer-directed health plans such as FSAs, HRAs and HSAs to your employees
Administer stop-loss protection for you

Contact Us

With quality networks and superior customer service, we're known as experts in managing health plan operations. Let us guide you to the most direct and effective way to reduce the costs of your employee health care benefits. Call us today. We look forward to speaking with you about becoming self-insured through Scott & White Health Plan TPA Services and the many exciting possibilities we can offer your company.

For more information, please contact a Scott & White Health Plan office near you or request additional information online.

¹ Coverage underwritten by Metropolitan Life Insurance Company, New York, NY 10166.
² Coverage underwritten by the Insurance Company of Scott and White.

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