( also known as self-funded): A health plan under which an employer or other group sponsor, rather than an insurance company, is financially responsible for paying plan expenses, including claims made by group plan members. (3)
An insurance policy within a company where revenue is generated for insurance from associates and company contributions rather than paying premiums to an outside insurance company.
a) In relation to superannuation, referring to a fund which itself takes on responsibility for paying death or disablement benefits to its members rather than paying an external insurer to accept the risk; b) More generally, referring to companies who pay insurance premiums for their own business into a fund they directly control rather than using an insurance company to write a policy.
Employers who assume direct responsibility or risk for paying for employees' health care without purchasing health insurance. They usually contract with an outside firm to handle claims payment and/or utilization review.
A plan in which the insurance company or service plan collects no premiums and assumes no risk. In a sense, the employer or Benefit Fund providing the benefit acts as the insurance company, paying claims with the money ordinarily earmarked for premiums. Regardless of the specific self-funding technique a firm chooses, it will need either to buy its administrative services outside the company or develop them in-house. Hence, self-funded arrangements are referenced as “ASO”(administrative services only) or “self-administered.
To put money into an account ahead of time, to be used to pay any potential claims as they come up.
An insurance plan in which employers pay for medical claims out of their own funds rather than contracting with an insurance company for coverage. In this case, the company assumes the risk for its employeesâ€™ medical expenses, and will need to develop a program for identifying, evaluating and funding its losses. It is often used for workers' compensation, where losses are generally predictable. PureShare ActiveMetrics, a proactive metrics management application, helps monitor risk exposure and insurance claims.
Refers to companies which pay insurance premiums into an internal fund rather than an insurance company to insure themselves against selected risks.
To insure one's self with personal assets.
Health coverage in which health services are delivered by providers but the member's employer, not the insurance plan, bears the risk for any expenses incurred. These plans usually contract with a third party administrator, or an insurance company through an Administrative Services Only (ASO) arrangement, to administer the plan, including paying claims, determining eligibility, etc.
Employers who underwrite their own risk are known in the insurance industry as self-insured entities. Groups with favorable claims history are the best candidates for self-insured healthcare plans.
An individual or organization that assumes the financial risk of paying for health care. This term is usually used to describe the type of insurance that an employer provides. When an employer is self-insured, this means that the payer or managed care company manages the employer's funds whether than requiring the employer to pay premiums. Many employers choose to self-insure because they are then exempted from certain insurance laws and also think that they will spend less money in the short run. Employers assume the risks involved and also have full rights to all insurance claim information. Typically, the self-insured employer is a large employer. The employees or patients will not be able to discern if their employer is self-insured easily since all paperwork or benefits cards usually contain the name of the insurance company. Same as Self-Funded. See also Third Party Administrator.
Refers to companies who, rather than use an insurance company to underwrite policies, pay their own insurance premiums into an internal fund they have direct control over.
An Employer who underwrites their own risk. This may is good for groups with a favorable claims history.
The practice of an employer or organization assuming responsibility for health care losses of its employees. This usually includes setting up a fund against which claim payments are drawn and claims processing is often handled through an administrative services contract with an independent organization.