Self-Funding Dental: Leave No Stone Unturned

Self-Funding Dental: Leave No Stone Unturned

With all of the focus that is put into managing and controlling health care costs today, it amazes me how many organizations still look past one of the most effective and least disruptive cost-saving strategies available to employers with 150 or more covered employees – self-funding your dental plan. There is a reason why dental insurers are not quick to suggest making a switch to a self-funded arrangement … it is called profit!
Why self-fund dental?
We know that the notion of self-funding still makes some employers nervous. Don’t be nervous; here are the fundamental reasons why this requires little risk:

  1. When self-funding dental, your exposure as an employer is limited on any one plan member. Benefit maximums are typically between $1,000 and $2,000 per year.
  2. Dental claims are what we refer to as high frequency, low severity (meaning many claims, lower dollars per claim), which means that they are far less volatile and much more predictable from year to year.
  3. You pay for only what you use, an administrative fee paid to the third-party administrator (TPA) and the actual claims that are paid in any given month. That’s it!

Where do you save when you self-fund your dental?
Trend: In our ongoing analysis over the years, dental claims do not trend at anywhere near the rate that the actuaries from any given insurance company project (keep in mind these are very bright people that are paid to make sure that insurance companies are profitable). Therefore, insured rates are typically overstated.
Claims margin: This is money that insurance companies set aside for “claims fluctuation” (i.e., profit). For example, ABC Insurer (we’ll keep this anonymous) does not use paid claims in your renewal projection. They use incurred claims that are always somewhere between three and six percent higher than your actual paid claims. They then apply “trend,” a risk charge and retention to the overstated figures. This factor alone will result in insured rates that are overstated by five to eight percent on insured plans with ABC Insurer, when compared to self-funded ABC Insurer plans.
Risk charges: You do not pay them when you self-fund! This component of an insured rate can be anywhere from three to six percent of the premium.
Reserves: Money that an insurer sets aside for incurred, but unpaid, claim liability. This is an area where insurance companies profit. They overstate the reserves that they build into your premiums and then they earn investment income on the reserves. When you self-fund, you pay only for what you use.
Below is a recent case study
We received a broker of record letter from a growing company headquartered in Massachusetts. They were hovering at about 200 employees enrolled in their fully insured dental plan. After analyzing their historical dental claims experience, we saw an opportunity. After presenting the analysis and educating the employer on the limited amount of risk involved in switching to a self-funded program, the client decided to make the change.
After we had received 12 months of mature claims, we did a look back into the financial impact of the change. Had the client accepted what was historically a well-received “no change” fully insured dental renewal, they would have missed out on more than $90,000 added to their bottom line. Their employee contributions were competitive to begin with, so the employer held employee contributions flat and was able to reap the full financial reward.
This is just one example. I would not suggest that this is the norm, but savings of 10 percent are. If you are a mid-size employer with a fully insured dental plan, self-funding dental is a cost-savings opportunity you and your consultant should be monitoring at every renewal.
By Gary R Goodhile, Originally Published By United Benefit Advisors

Automatic for the People

Automatic for the People

With apologies to the band R.E.M., this article is not about their music, nor their album, but about how automatic enrollment has significantly helped people. Think of all the payments you currently have automated. You probably have automatic deposit of your paycheck, automatic bill pay for your utilities and other monthly bills, and maybe even a recurring automatic payment and delivery of pet food from Amazon. Now, think of something that’s important that you wish you could automate. This is not the time to mention your daily fix of Starbucks, but about saving enough money for retirement.
There are families that have a similar system where they placed a large jar in the kitchen. Everyone, kids included, would put their spare change in the jar every day. At the end of the month, the family would use that accumulated money in a fun way. An article titled, “Automation Making Huge Retirement Plan Impact,” in Employee Benefit News references how a defined contribution plan provides an excellent way for employees to seamlessly save money for retirement. As employees started joining the plan, with a typical contribution of 10 percent or higher, including employer matching, participation increased nearly 20 percent in the company’s retirement benefit according to the article. This was up more than seven percent from just five years ago. Looking at this by generation, millennials are used to automation and, consequently, are reaping huge rewards from this type of plan.
However, all age groups benefit and a company can modify the plan to increase participation. For example, if a company has a matching rate of 50 cents on the first three percent to 25 cents on the first six percent, it automatically gets employees saving an additional three percent they wouldn’t normally save. Another way is to have annual automatic increases in contributions. A bump of a percentage point every year up to a maximum rate will help employees the earlier they start.
Of course, there should always be an opt-out option for people who don’t want to have the contribution rate increased, have a separate retirement plan, or simply don’t want to save using the company plan.
By Bill Olson, Originally Published By United Benefit Advisors

The Best Ways to Minimize Your Risk When Selecting a Stop Loss Carrier – Part 2

The Best Ways to Minimize Your Risk When Selecting a Stop Loss Carrier – Part 2

In the first part of this two-part blog, I recommended a number of important items to keep in mind as you select a stop loss carrier. Additionally, here are a few other things you will want to look for, or ask about, when selecting a stop loss carrier. While this is not an exhaustive list, these are some of the most frequent items I have seen that cause issues or gaps in coverage.
Plan Mirroring
Does the stop loss carrier “mirror” its policy to your employee benefit plan document? I like to think of this whole plan mirroring approach as kind of hand in glove. The relationship between the employee benefit plan document and the stop loss policy should be a complement to one another.
Your employee benefit plan document and your stop loss policy are two separate documents containing many different provisions and terms. Without plan mirroring, stop loss carriers will audit to their stop loss contracts, which can, and do, result in gaps in coverage. Make sure you work with a carrier who will provide plan mirroring.
Medical Necessity Determinations
Although a stop loss carrier can follow plan language, some do, and will, question determinations made by the plan for medical necessity. Stop loss carriers differ on their level of scrutiny in this area. The reality is the medical field is not always black and white on how to treat a patient. It is important to understand the carrier’s position and also the medical guidelines used by your administrative services only (ASO) carrier or third-party administrator (TPA) in making medical determinations.
Recognition of Network Requirements
With your employee benefit plan, you are most likely using a preferred provider organization (PPO) network where provider claims are subject to payment based on an agreed schedule. The agreement you have to access this network predicates what the plan will pay the provider for their services.
A stop loss carrier who is not party to this agreement may question the payment methodology, or feel it can do better on certain claims. They rely on cost containment vendors to review claims and determine what they might feel would be “reasonable” payments. If this is the case, you, as an employer, may be left with a gap in coverage as you are required under your employee benefit plan to reimburse the provider at the contracted rate, but your stop loss carrier may not reimburse you to that level.
It is important to know your stop loss carrier’s position on this type of situation.
Claim Turnaround
Find out what the carrier’s commitment is to paying claims. Many carriers have standards that can vary greatly by carrier. With stop loss, you are typically dealing with large dollar amounts and from a cash flow perspective, you want to know what your carrier’s policy is regarding claims payment.
Will the carrier allow for “advanced funding?” If so, the claim is first adjudicated and processed, but not paid until the stop loss carrier has reimbursed the portion over the stop loss deductible. This, in turn, minimizes the disruption to your cash flow. Many, but not all, carriers offer advanced funding and some will charge an additional fee.
You will want to check with your broker or administrator on the carriers you are considering and what their specific requirements are for advanced funding.
Reasonable and Customary (R&C)
R&C is also known as usual and customary (U&C). As noted earlier, most employee benefit plans take advantage of PPO networks, where provider claims are subject to payment based on an agreed schedule. Outside of claims through a PPO, most plans limit claims payments or reimbursements to R&C charges. This describes the amount an ASO carrier or TPA decides to use as the starting point in the payment for a service.
In each case, it is important to ensure that the employee benefit plan’s definition agrees with the stop loss policy, or that the stop loss policy will follow the provisions of the employee benefit plan.
Secondary Network Access Fees
Typically, a TPA or ASO carrier will provide access to a “secondary” or specialty-type network, such as a transplant-only network. The advantage is that the employee benefit plan and member gain access to discounts, or additional discounts above and beyond that of the primary network offering.
In these cases, there is typically an access fee usually set as a percentage of the savings achieved that is the responsibility of the employee benefit plan. These fees are NOT always reimbursable by the stop loss carrier, or the stop loss carrier may put a limit on the amount reimbursed.
Check with your broker or administrator on whether stop loss carriers you are considering will reimburse you for these types of fees.
While these six considerations are not a comprehensive list, they will certainly set you on the right path for discussions with your broker, or administrator, on selecting a stop loss carrier that not only meets your needs, but also provides the protection necessary for your employee benefit plan and company.

By Steven Goethel, Originally Published By United Benefit Advisors