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What is Self-Funding?

  • What is Partial Self- Funding?

Typically, only the largest companies can afford the risk associated with 100 percent self-funding. When most companies consider self-funding, they are actually dealing with partial self-funding. Partial self-funding means a re-insurance or stop loss policy is purchased to limit the risk. 

There are two distinct types of re-insurance policies: 

    • Specific Stop Loss reimburses the employer for catastrophic claims on any single individual or member paid in excess of a certain dollar amount
    • Aggregate Stop Loss reimburses the employer when the total of all employees and dependent claims exceeds a certain dollar amount
  • How does Partial Self Funding work? 

An employer establishes an account for paying claims up to the pre-determined stop loss reinsurance amount. This account may be pre-funded or funded as claims are paid. The Third Party Administrator (TPA) pays the claims out of this account and works collaboratively with ConnectCare. 

  • What are the benefits of Partial Self-Funding through ConnectCare? 
    • Retention:  The employer retains case reserves for further claims that are typically accumulated by insurance companies
    • Elimination:  Premium taxes payable to the state are eliminated
    • Reduction: Costs of administration, commissions, claims processing and printing fees are reduced significantly
    • Flexibility:  The employer games flexibility and maintains control of the plan

Partial self-funding assists employers in providing cost-effective health care benefits.  With increased cash retention, tax elimination, administrative cost reduction and better flexibility, self-funding allows the employer to manager employee health benefits while protecting the financial well-being of the organization.

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NCQA Certified Utilization Management"Achieving Utilization Management Certification from NCQA demonstrates that ConnectCare has the systems, process and personnel in place to conduct utilization management in accordance with the strictest quality standards." -- Margaret E. O'Kane, President, NCQA

NCQA has reviewed and certified ConnectCare's Utilization Management functions only. For complete details on the scope of this review, visit www.ncqa.org.