24 Hour Occupational Coverage

[Executive Benefits]

I have a large railroad group that I am working on and they are requesting 24 hour occupational coverage for group health... All I can find is the current carrier Lloyds of London.

Anyone know of another carrier?

 

[somarco]

How large?

And why are they looking for 24 hour coverage? Don't they have WC?

 

[ABC]

"24 hour occupational coverage for group health"

Why is that an issue?

 

[Executive Benefits]

Over 50 employees, this is a strange case, because they are railroad workers they are classified as Federal Employees, and do not have to carry Work Comp so they need the 24 hour coverage.

I think Lloyds may be the only one that has it. :( I've searched high and low

 

[somarco]

You will most likely have to self fund the medical to get the 24 hour coverage. I can't think of a fully insured carrier that will do that.

Since they are with Lloyds now they are accustomed to the self funded concept. Lloyds is a non-admitted, surplus lines carrier.

Rather than going through the machinations of shopping TPA's and stop loss carriers, the simple thing would be to take over by AOR.

 

[ABC]

Wow
This is really an interesting case.

From a fully insured standpoint I only know one carrier that offers occupation coverage and that is American Community.

I don't think I would self fund a group this size for the health.

What a cool case to be working.

Good Luck

 

[somarco]

I have had several cases self funded that were smaller than that in the past. If you have the proper stop loss in place it is no big deal.

If they really want to explore other options, they should purchase WC separately rather than trying to fund (at least a portion of it) through their medical plan.

I had a case similar to this years ago with a short line RR that (as I recall) terminated in Deerfield Beach. I don't recall all the details, but we proposed a self funded plan at the time. I can't say whatever happened to that prospect.

 

[ABC]

I have had several cases self funded that were smaller than that in the past. If you have the proper stop loss in place it is no big deal..

I have taken a few groups that were under 50 that were self funded and fully insured them and saved them large amounts of money. If you wanted to mirror a self funded plan why not just put in a fully insured HRA?

 

[somarco]

If you wanted to mirror a self funded plan why not just put in a fully insured HRA?

When we were self funding groups down to 25 lives (10 in FL) there were more reasons then than now.

HRA's & HSA's did not exist. Even with those provisions there are still reasons to self fund vs. going the fully insured route. Not the least of these is the ability to bypass state mandates.

At one time (and possibly now as well) FL had a list of mandated benefits that added quite a bit to the cost of health insurance. ERISA plans are exempt from state mandates so you can sometimes save 20 - 30% or more when you don't have to cover things like IVF.

In this case, finding a carrier willing to offer fully insured 24 hour coverage is another bugaboo. Much easier to do that with a stop loss carrier.