LifeWise Assurance Company provides self-insured employers the security they need. As a member of the Premera family of companies, we can offer you the security and resources of a major regional carrier and the dedicated, individualized service of a local company.
In self-funding arrangements, a company establishes and maintains a fund to cover claims instead of paying premiums to an insurer. Benefits and eligibility are typically similar to traditional health plans. While self-funding involves greater risk, most companies purchase
stop-loss coverage to protect against catastrophic claims.
Stop-loss coverage, also referred to as excess medical, medical stop-loss and medical reinsurance, is insurance coverage purchased by groups that provide self-insured health benefits. Under a stop-loss policy, the stop-loss carrier becomes liable for losses that exceed certain deductibles. Stop-loss is different from conventional employee benefit insurance in that stop-loss protects self-insured employers. It does not insure employees or dependents.
This coverage provides security to companies that self-fund their health coverage. Policies typically protect against both individual catastrophic claims and aggregate claims over the contract period.
Once a self-funding plan is set up, it works essentially the same as a traditional health insurance plan. Providers file claims for doctor visits, prescriptions, and other medical expenses. Instead of a going to an insurance company, claims go to a third-party administrator to be paid from the fund established and maintained by the employer. The biggest difference is complete transparency of claims processing and detailed reporting.
Most groups that self-fund find greater cost control to be the biggest benefit. Armed with detailed claims reporting, employers can take proactive measures to reduce health risks specific to their workforce and reap savings on healthcare expenditures.