DO YOU KNOW WHAT IT MEANS TO BE SELF INSURED? I have seen very lively and very disgruntled discussions here and on other sites about UHC insurance. You are NOT insured by UHC. DL is a self insured company. UHC is their TPA (third party administrator - this is an insurance term). Being self insured is not in and of itself a bad thing. Theoretically, it should be a good thing. With self insurance corporations can save money and theoretically design plans to fit its employees needs. They can do this because with self insured plans they have almost total control over what is covered, what is not covered and how much the employees pay. With traditional fully insured plans you pay a premium to the insurance company and they hold all the risk. With self funded insurance the premiums you pay go into the fund to pay all future claims. UHC does NOT pay your claims from their funds. They are hired and paid administrative fees to pay your claims out of your employers self funded pool. Your employer makes all the rules (within regulations) and UHC acts as the third party administrator (TPA). Monies in a self funded pool collect interest. I am not sure what happens at the end of a fiscal year, whether that money stays in the pool or returns to the corporation as monies not paid out. Ill try to find out. Below is a very simple piece on what self insured means. There is plenty more to find out using google. With a union you will have a voice in what is covered and how much you pay. Without one, they have almost total control. Only union contracts can negotiate health benefits. I hope the piece below gives people some insight into what self insured means. What is a self-insured employer plan? Many people aren’t sure whether the health plan they have through their employer is fully insured or self-insured. But if you work for a large company or government, there’s a chance your health plan is self-insured. These self-funded plans are not insurance. The employer pays employee health care costs from the employer’s own pocket. That’s why these self-funded plans tend to work best for companies that are large enough to offer good coverage and pay large claims for expensive medical services. A self-insured plan may seem just like traditional insurance to you, but it does not always work the same way. And the differences can be important. Of course, as long as claims are being paid you may not notice whether your employer is fully insured or self-funded. How do self-insured employer plans work? Self-funded employers normally hire third party administrators (TPAs) to keep track of premiums, claims and related paperwork. • Some insurance companies contract as TPAs. This can disguise the facts if your plan is self-funded. • The names of both the TPA and employer appear on the benefits handbook and claim forms — just as if the TPA were actually your insurance company. • A self-funded employer takes on the roles the insurance company usually plays, including paying claims, deciding on benefits and which claims to pay. • TPAs simply follow the employer’s orders.
Posted on: Sat, 28 Jun 2014 01:46:02 +0000
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