From greater flexibility to lower costs, self-funded insurance is attracting the attention of more and more employers.
“Self-funding plans have been gaining popularity as a way for companies and employees to save money in the face of the recession, recent health care reform and increasing health care costs,” says Mark Haegele, director, sales and account management, for HealthLink. “Health care reform adds a number of taxes and restrictions on fully insured companies that those on a partially self-funded basis are typically able to avoid.”
Smart Business spoke with Haegele about how you can manage a self-funded plan to ensure your company gets the most out of its health care expenditures.
What’s the difference between a self-funded and a fully insured health plan?
With self insurance, or self funding, the employer assumes the financial risk of providing health care insurance. Typically, the company sets up a trust of corporate and employee contributions that are administered in house or subcontracted to a third party. A company can either hire a third-party administrator (TPA) or do the administration itself to save on fees that would normally go to an insurance company. A TPA can also take on fiduciary responsibility with reinsurance to further protect the employer.
When an employer is fully insured, it pays a fixed premium to an insurance carrier that assumes all of the risk.
Why would an employer choose to self-fund?
There are a number of reasons to go with self-funded insurance, and flexibility is one of the biggest selling points. For example, Company A can choose to exclude bariatric surgery on its health plan and Company B can include it, depending on its employees’ specific needs. In Illinois, the state mandates that fully insured businesses must pay for bariatric surgery, so only with self-funding do businesses have the ability to choose.
In another example, under self-funded insurance, an employer can identify disease prevalence and assign benefits to accommodate its employees’ specific needs. So, if an employer discovers a higher incidence of asthma and diabetes in its employee population, as a self-funded employer, it can choose to pay 100 percent of all of the services required to manage those illnesses. This keeps employees healthier — and out of the costly ER and hospital — by ensuring they maintain their treatment protocols for that particular illness.
It’s about identifying the makeup of the employee population, and designing and building self-insured plans to really support that population’s needs; you’re not stuck in a box of what you have to provide, based on what the state mandates or on your insurance company’s systems.
In addition, you can maximize your interest income on premiums that would otherwise go to an insurance carrier, and you can avoid prepaying for health care coverage, improving your business’s cash flow.
Finally, self-funded insurance is only subject to federal law, not conflicting state health insurance regulations and/or benefit mandates and state health insurance premium taxes, which can account for 2 to 3 percent of premium costs.
How common is self-funded insurance and how can a company determine if it is the best option for its needs?
Approximately 50 million employees and their dependents receive benefits through self-insured health plans, which accounts for 33 percent of the 150 million participants in private employment-based plans nationwide, according to the Employee Benefit Research Institute in 2000.
There’s a myth that self-funded insurance is not cost effective for employers with fewer than 1,000 employees. However, there are many TPAs that offer partially self-funded programs for companies with as few as 10 employees. In most states, including Missouri and Illinois, health care is a guarantee issue for plans with fewer than 50 lives. This means if you have 50 or fewer employees and you try self-funded insurance but it doesn’t work out, health insurance carriers must allow you to have fully funded insurance the following year.
However, if you have between 50 and 100 employees, you need to truly understand your risks because returning to a fully funded plan from a self-funded plan could increase your rates dramatically. Make sure that you have a trustworthy broker and/or lawyer review the plan you’re going to participate in before making your decision.
If a company assumes the risk of self funding, how can it protect itself from a catastrophic claim?
You can purchase stop-loss insurance for reimbursement of claims above a specified amount through a TPA. Only the employer is insured, not the employees or health plan participants, which means you can avoid most insurance taxes.
There are two types of stop-loss insurance, which acts as reinsurance:
- Specific stop-loss provides protection against a high claim on any one individual. The rule of thumb is $10,000 if you have 10 employees, $20,000 if you have 20 employees, etc.
- Aggregate stop-loss offers a ceiling on the amount of eligible expenses an employer would pay, in total, during a contract period. The carrier reimburses the employer at the contract’s end for aggregate claims.
You also can use TPAs to help decrease your risk. A TPA will have existing affiliations with health care networks to help manage the plan and save the most money. TPAs can also help manage the increased complexity of self-funded insurance.
Self funding is more viable than ever for employer groups with as few as 10 employees. Right off the top, employers save 3 to 5 percent of the total cost of their health plan through insurance companies’ risk charge and profit, coupled with the other advantages of plan design flexibility and additional tax avoidance associated with health care reform.
Mark Haegele is a director, sales and account management, for HealthLink. Reach him at (314) 753-2100 or Mark.Haegele@healthlink.com.
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Emerging from the darkest days of the great recession, Richard Bolte Jr. came to one undeniable conclusion: Predictability was gone. It left with the economic downfall in 2008, and it wasn’t coming back.
Change was the new constant for his company, BDP International Inc., and he needed to adapt BDP to deal with the new reality.
“The financial crisis left us with unpredictability and market volatility,” says Bolte, BDP’s president and CEO. “So as a result, it’s a new environment that is volatile and unpredictable, and you have to transform and change, as well. You can no longer serve your market with that business model. Your customer requirements have changed. They’re moving their supply chains around. They’re making different decisions. They’re looking to outsource things they used to do themselves.”
To react to the new volatility, Bolte had to transition his company from a controlled, structured environment to a company that nurtured new ideas, promoted innovation and valued entrepreneurship. It was a dramatic shift for the global logistics solutions provider, which generates $1.65 billion in annual revenue and employs 3,000. It meant not just new processes and policies, but a complete reconfiguration of the way the company collectively thinks.
And to make it all happen, Bolte had to start at the individual level and work his way up.
“The challenge I gave to our guys was, rather than looking at global operations as something that needs to be controlled, you need to ask one question: ‘How can I help you grow?’ he says. “That would underscore and focus the team on transformation, because from a support perspective, it is quite a journey to go from controlling to nurturing.”
Build the case
As Bolte and his leadership team surveyed the damage from the recession, he came to the conclusion that the companies that could adapt on the fly would be the companies that survived. Knowing that, he realized one of his first duties as the head of the organization was to create a sense of urgency around the need for change. He needed a management team that wanted to embrace change now, not a year from now.
“It’s one of the things you need to do as a leader,” Bolte says. “The message needs to keep coming out that we’re not kidding, we believe we need to migrate to these things. We need to change and why. You’d better have a good answer as to why you believe things need to change and why they need to change now. Because even if you get buy-in on change, you might find those who want to change in a year or so. So you need to create that sense of urgency. You need to create a tremendous sense of clarity around why you think things need to change and why they have to happen now.”
Bolte built the case for change by collecting and presenting data to his managers, and then cascading that data throughout the organization. Bolte and his leadership team built a three-year strategic plan that identified where BDP currently stood and where it needed to be in 36 months to maintain profitability. The basic points of the plan were then rolled out to every corner of the organization.
“We came out with a three-year plan that says, ‘As a result of going through this crisis, things need to change, and here are the things we’ve identified that need to change now,’” Bolte says. “Then we communicate that through town-hall meetings, through webcasts, through our management team and senior team. We embedded those exact same messages into their communications. We then developed a strategic plan and published progress as to how we were performing against those changes we had identified.”
The change areas that Bolte and his team identified centered on what he calls “centers of excellence.” Bolte wanted employees in each area of the company — IT, finance, global administration, sales and marketing, and transportation services — to identify ways in which their department could evolve into a more entrepreneurial, innovative team. It was easier for some areas than for others, and in some cases, it took a personnel shift to fulfill the company’s shift.
“Let’s take finance, which is controlling by nature,” Bolte says. “One of the things we looked at is that finance can be a valuable tool to the organization, if employed correctly. It can be a partner to growth instead of a ‘threat to be audited’ kind of mindset. One of the things we had to do was actually look at the people within the organization.
“Some individuals are actually not going to be able to make that leap over to a nurturing environment. We actually had to go out and bring in new and different talent into organizations like finance and IT, who thought in different ways and could accommodate that kind of transformation.”
Even though the organization was shifting away from centralized processes, Bolte was starting to rally BDP around a strong central vision, which required buy-in from people who also embraced the vision, necessitating the need for new blood in certain positions.
“The notion we asked them to embrace is that we need to create an environment that is easy to do business in, where we treat people how you want to be treated, not a highly structured or controlled environment,” he says.
But with that newfound need for entrepreneurship and innovation comes a need for boundary lines. You might not want rules weighing down your people, but you can’t let them innovate themselves into left field, where their ideas do nothing for them or the company.
Bolte harnessed his employees’ brainpower and used it to cement his new culture by turning innovation into a competition of sorts.
“Last year, we actually had a specific program we named BDP Fusion,” he says. “We encouraged employees anywhere in our system to submit ideas for a new business plan. We then held a contest in each region where we picked the top three ideas. At the end, it boiled down to one winner, and we actually implemented that idea as a new business plan. We had contests in three regions and myself and some other senior members went around, and the finalists were able to present to us.
“There was a tremendous amount of energy and excitement around these teams presenting, and in addition to ending up with a great business plan for tank management in Asia, it was very good for morale. A lot of companies say they listen to their employees, but here was visible evidence of a company seeking direction on a new business from its employees. It sends a powerful message that we do listen and we do care about these new ideas.”
Build change agents
You can hire people who will embrace your vision for the future, but until you can fully leverage their ability as leaders, you won’t have much more than passive order takers.
You not only want your best and brightest to get on board with a new organizational direction, you want them to get others on board, too. In some companies, they’re called change agents, but whatever title you want to stamp on them, they’re a critical ingredient in making your vision a reality.
At BDP, Bolte has formalized the process of getting buy-in from his future leaders, partnering with outside resources to train and enable the next generation of change agents.
“We went and aggressively developed what we call a leadership development program involving the top 40 or 50 next-generation-type leaders,” Bolte says. “We did a partnership-type program with [Dale Carnegie Training]. We did a two-week course with instructors from Dale Carnegie, but we also developed a program with senior staff from BDP, where we ran a highly energetic and entertaining two-week session. The energy coming out of that was tremendous.”
The training program goes hand in hand with an internal mentoring program that Bolte and his leadership team initiated. The mentoring program is designed to give potential leaders a wide-angle view of the company by pairing the young protégé with a mentor from a different department.
“It’s very cross-functional in our case,” Bolte says. “We might have the CFO mentoring two people in operations. Or you might have an operations person mentoring someone in the finance department. The mentoring process is a bit better than just identifying top performers. It takes it a bit deeper, because you’re getting direct feedback from senior management members who had these individuals under their wing for the program, which runs six months. So I think you’re developing a deeper understanding of your top performers.”
But sometimes, it comes down to the lessons learned from your years of experience as a manager of people. If your gut is full of experience, it’s OK to trust it sometimes.
“In addition to the processes, don’t be afraid to use your gut feelings,” Bolte says. “Sometimes you’ll get a good sense about somebody, and in business, I think you can trust your sixth sense, so to speak. But other than that, if you do not have a mentoring process or a leadership development program, you should study various forms of those types of programs and consider implementing them.”
Maintain your momentum
Once you have forged a new direction for your company and gotten all of your key players on board, your job isn’t done. You have to keep enforcing the rulebook and reinforcing the behavior you want to see.
In the final months of 2010, Bolte was involved in budgeting and strategic planning meetings for the upcoming year, as many company presidents and CEOs were. But he took the opportunity to reinforce the direction of the company through the budget and planning process.
“These meetings that we’ve been having internally are designed to build complete alignment among the business units and the infrastructure that supports them,” Bolte says. “They all have an agreement that these are the priorities for 2011, this is the order that we hope to accomplish them, here are the critical success factors, and so on. So there are different elements of the plan, and we come together and sign off on it — ‘This is how we’ll move forward as a team.’
“I like the simplistic approach. You don’t need a 51-page strategic plan. You need strategic principles and a two- or three-page paper, and that is really the strategic plan. Because if anything is bigger than that, you start to lose people.”
Bolte says you still need to allow your team to bounce ideas off of each other and off of you. You can’t throw water on innovative brainstorming. It simply goes back to ensuring that you have broadly defined the direction in which you want everyone pointed and nudging people back on track when they stray.
“If it’s something I don’t like, I’m pretty quick to tell them,” he says. “If you think of it like they’re presenting their wish lists, I don’t give much comment unless they’re really in an area where I think it’s not aligned with our vision. So it’s really an opportunity to listen to those plans, see how it’s going to impact the whole group and figure out what they’re going to need to do to support those plans moving forward. That’s how you keep everyone on the same page with regard to a vision.”
How to reach: BDP International Inc., (215) 629-8900 or www.bdpinternational.com
The Bolte file
Richard Bolte Jr.
president and CEO
BDP International Inc.
Education: Business/finance and Spanish degrees, Mount St. Mary’s University
What is the best business lesson you’ve learned?
You can’t do business with people or companies you don’t trust. If you don’t have that element, you can’t have a relationship, and you can’t do business.
What traits or skills are essential for a business leader?
You need to be a great communicator and have really strong public speaking skills. You need to be trustworthy and ethical, be passionate about what you do, and show that passion when you have the opportunity.
What is your definition of success?
Meeting all predefined goals. But you can define it in other ways. Success can be creating a successful culture, and that means not accomplishing a goal but how you accomplish a goal. Did you do it in a moral and ethical way?