• New Edge Solutions

Myths of Self-Funding: Fully Insured Carriers Have the Best Networks



Welcome back to our Myths of Self-Funding Series. In our previous entry, we discussed the myth that self-funded plans are too risky but found that the risk can be mitigated through a combination of underwriting, plan features, and population health strategies.


Today, we explore the myth that fully insured carriers have the best networks. Although this popular myth persists, the reality is that it’s just not true.


If you remember, in a self-funded medical plan, the employer pays the claims that their members incur for their health care. It stands to reason that the employer would want the deepest discounts on the services that their members use, but fully insured networks have the best discounts, right?


The answer is - not always.


Self-Funded plans provide the flexibility to offer multiple national networks achieving similar results as the fully insured carriers. Employers that have multiple locations can take advantage of best-in-breed networks that provide coverage and discounts for both employer and employees.


To top it off, some medical systems throughout the country have a desire to work more directly with employer groups, allowing them to have a greater impact on the health of their community. These community health plan arrangements offer deeper discounts than they would through a traditional network and with a significantly reduced access fee.


Discounts on networks are only one part of the equation. What good is a discount if the carrier isn’t doing anything to reduce the risk on the health plan? It’s death by a thousand cuts. Add population health strategies and disease management tools to reduce claims and you have a combination for controlled and sustainable health care costs.


A Self-Funded plan offers more flexibility with customized network options and innovative discounted plans from health providers who want to make a difference in their communities.


To learn more about the self-funded Direct to Employer plans we have available, contact New Edge today.

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