Imagine it's a crisp October evening 🍂. The leaves are turning, and there's a slight chill in the air 🌬️, the kind that whispers of Halloween 🎃 approaching. This time of year always brings excitement and a touch of mystery 🕸️. Let's talk about something daunting yet equally thrilling for your business: self-funded health benefits.
Think of self-funded health plans like choosing your own Halloween adventure 🧛♂️. Initially, it might seem unsafe, like walking through a dimly lit, fog-covered path 👻, not knowing what's around the corner. But just as you bravely step forward, lantern in hand 🏮, you discover there's nothing to fear and everything to gain from this journey.
This month, I'm here to guide you, shining a light 🔦 on understanding self-funded health benefits. Let's explore together with a sense of curiosity and anticipation 🕯️:
- Discovery - Like unearthing an old, dust-covered book 📚 with ancient secrets, learning about self-funded health plans will reveal valuable insights. Unlike traditional health insurance models, this approach offers flexibility and freedom you didn't know was possible.
- Clarity - Think of this as casting away the cobwebs 🕸️, clearing all your misconceptions about self-funding. It's not nearly as complex or risky as it might seem at first glance, quite the opposite.
- Customization - Here's where you get to mix your own potion 🍵, so to speak. Tailoring a health plan to meet your team's unique needs can create a happier, healthier workforce. Imagine crafting a plan as unique as your favorite Halloween costume 🧙♂️, designed specifically for your company and no one else.
Embracing self-funded health benefits might require a leap of faith, like stepping into a haunted house 🏚️, not knowing what adventures lie inside. But remember, I'm here with a flashlight 🔦 to guide you through. Every step towards understanding and implementing a self-funded plan can lead to rewards you never imagined, from cost savings to a more engaged and satisfied team.
As you watch the leaves change and plan your Halloween costume this season, why not explore the potential of self-funded health benefits? It could begin an exciting new chapter for your business, filled with possibilities and the promise of a future crafted precisely to your vision 🌕.
As you embark on the journey of self-funding your health benefits, it's like navigating through a misty, moonlit night 🌌 ripe with myths that can spook even the bravest of hearts. But fear not! With your lantern in hand 🏮, let's shine a light on these common misconceptions and uncover the truth that lies beneath. It's time to transform your understanding and approach to healthcare benefits this Halloween 🕯️.
Myth #1: "Employees are wary of technology, like a cat 🐈 to water."
Boo! This one couldn't be more wrong. In reality, 86% of people reported feeling comfortable with healthcare technology. Most people crave the convenience of modern tech giants like Amazon and Uber in their healthcare management. They're not running away; they're reaching out for more. So, let technology be your broomstick 🧹, guiding you to more efficient healthcare management.
Myth #2: "No potion 🍵 can improve utilization—especially not employee education and communication."
Another tale that crumbles under the light! The magic potion here is indeed effective communication and education. Like gathering ingredients for a powerful spell ✨, combining ongoing, diverse (email, text, and video), and easy-to-understand resources can make all the difference. It's about making healthcare decisions as simple as picking the best pumpkin 🎃 in the patch. Empower your team with knowledge, and watch the barriers to healthcare vanish into thin air.
Myth #3: "Employees are like vampires 🧛♂️ to change—avoiding it at all costs."
It couldn't be farther from the truth. Just as vampires transform, so too can employees embrace change—when they see the benefits. Illuminate the perks and improvements like houses with the best Halloween treats 🍬, and watch as employees approach change not with fear but with anticipation. It's all about showcasing the value in a way that resonates with them, turning skeptics into believers.
Don't let these myths haunt your efforts toward a healthier, more informed workplace this Halloween. Addressing these fears with truth and clarity will help you find the path to successful self-funding that is not spooky. Here's to unmasking the myths and embracing a future of empowered healthcare decisions! 🛡️🎃
Then, Enrollment commences, and your protection is spellbound! 🛡️🎃
Trick or Treat: Unveiling the Shadows of the BUCAs
Venture into the night where the BUCAs [Blue Cross Blue Shield, UnitedHealth Group, Cigna, Aetna (CVS Health), and Humana] lurk, these publicly traded ghouls expected to conjure profits for their shareholders with each full moon. 👎🏽
Their allegiance to the mighty dollar clashes like clashing swords with any duty they owe to you, their client. Your premiums fund their bounty.
Federal spells limit the potion they can brew — with only $20 of every $100 able to be mixed into administrative brews, marketing spells, and their cauldron of profits. The dark magic reveals that the higher your payment, the larger your treasure chest grows.
The status quo — this ancient curse of traditional health insurance — binds employers to accept yearly incantations of cost increases, shift burdens onto employees, and hopelessly wish upon a star for a better next year, a wish that never comes to pass.
Employees watch their real wages diminish 📉 like a fading ghost until they vanish to realms with more enchanting benefits on a night of revelation.
The three specters (3) of pharmacy benefits managers (PBMs)—CVS Health (CareMark), Express Scripts (Cigna), and OptumRx (UnitedHealth Group)—though shrouded in mystery, also serve the shareholders' crypt, not the humble client seeking sanctuary.
Affiliations with these insurers and PBMs, under such a dark pact, keep you from the elixir you truly seek.
The night's call is clear — Self-funding breaks the ancient curse, opening new pathways.
Relying upon the BUCAs is akin to pressing the cursed button 🔴 once a year. They wrap your benefits like a mummy, bundling administrative services, stop-loss insurance, network partners, and a PBM.
Yet, this convenience is a trick, offering hands-free health benefits at the cost of higher renewals, premium taxes, and processes that fail to catch errors, allowing fraud, waste, and abuse to creep in like unwelcome spirits. And when fortune smiles on your organization with lower claims, the carrier hoards the surplus.
Choosing to unbundle with a sage self-funded advisor means selecting the best arcana for your quest: an independent third-party administrator (TPA), PBM, stop-loss carrier, and network. You gain access to the archives of your plan data, casting light on informed, spell-bound, cost-containment strategies.
It signifies that you're not alone on this quest. Now, more akin to a wise guide, your advisor will unravel and execute these strategies, fashioning a health benefits plan that dances harmoniously with your goals and values.
Advisor
Your advisor's fee should resemble a ghost 👻 — completely transparent.
In traditional health insurance, carriers enchant advisors with commissions, luring them with the promise of treasure for renewing their allegiance. No incentive exists for them to unleash savings upon you.
Instead, ally with a self-funding advisor whose compensation is as clear as day, paid a flat fee with a bonus tied to the gold they discover for you, incentivizing them to toil for your benefit.
To embark on this adventure of stellar self-funded health benefits, employ an advisor who:
✔️ Is motivated by your savings and quality victories.
✔️ Practices the art of transparency in compensation.
✔️ Upholds your sacred duty as the guardian of your plan's treasure.
✔️ Conjures innovative solutions, ensuring a continual stream of savings.
✔️ Is eager to align you with kindred spirits in service providers.
Committing to the right guide is a pivotal first step on your journey to self-funding.
Third-party Administrator
Ally with an independent TPA that weaves its magic closely with yours and your advisor's, executing the everyday enchantments of your health plan, including:
✔️ Enrollment
✔️ Eligibility verification
✔️ Claims processing
✔️ Direct contracting
✔️ Customer service
✔️ Establishing direct primary care
You entrust them with your gold; in return, they toil for you, their objectives mirroring yours.
Pharmacy Benefits Manager
Summoning savings from the realm of Pharmacy presents an immense opportunity.
Clarity is as vital as a witch's crystal ball in this domain. With an independent PBM, you'll peer into the actual cost of concoctions, ensuring markups are mere illusions.
You retain the power to alter the potion list as needed to reduce costs without sacrificing the potency of your brews, demanding alternative sourcing strategies like assistance from the potion manufacturers and international cauldrons.
Trust your PBM to handle all things related to potion benefits, including:
✔️ Potion claim processing
✔️ Negotiating discounts with potion masters and apothecaries
✔️ Overseeing potion usage
✔️ Establishing owls for potion delivery
✔️ Guiding members to manage assistance programs
✔️ Unveiling opportunities for international potion procurement
✔️ Managing savings in the enchanted potion supplies
Whoever holds the potion book and reaps the rebates from the potion masters holds the key to financial victory — ensure this power is yours.
Recruit a cabal of experts to guide and protect you as you cast aside the old spell book in favor of controlling the magic needed to offer high-quality, affordable benefits to your guild.
Self-funded health benefits, once thought to be cloaked in mystery, illuminate the night.
Self-funding is not as terrifying as it may seem. 👻
The journey begins anew.