Small Group Health & Reform

[stuy119]

Is dental a mandated benefit under the new plans? If so, will this take away from dental insurance for groups, or is that still "voluntary" and not taxable?

 

[Bruce]

Lee,
I have heard of this approach before but every time I quote the numbers they are higher than what the fully insured premium is.

Can you post a group comparison on a fully insured plan vs your self funded option? Small group

Starmark has a refund eligible self-funded plan down to 10 lives:

http://www.starmarkinc.com/email/starmark/T701-51.pdf

I have not used it. Looks like fund to the max liability, carrier covers Stop Loss Claims as they go along. Downside seems that 'surplus position' is not known until 4 months after plan year which makes sense but you are not eligible for return of surplus if you cancel. Plus, the carrier keeps 1/3 of the surplus as a "delayed admin fee."

I understand the attraction of small group self-funding and certainly appreciate that others see it as more viable than me for small group.

I just don't believe in there being any such thing as an especially healthy 20 life group.

There are ok 20 EE groups and bad 20 EE groups (jammed up with ongoing or Dx's.). The credibility of a healthy 20 EE group is very low. I am very skeptical that a side by side of a FI and PSF quote from the same carrier with the same benefits is going to look any different than with the PSF Expected cost a few %% below the FI cost and Max PSF about 120% of FI, assuming a 125% Agg. There is only just so much retention cost you can save from PRemium Tax, etc... savings.

I suppose if a group is coming off a bad year and is cleaned up and the incumbent is hammering it anyway, a side by side of the new carrier PSF vs the incumbent renewal would look very attractive and that's where it could make sense to me.

I guess I need to look at a couple of quotes to get it fully straight.

 

[ABC]

I have yet to see any partial or fully self funded approach for small group that makes sense.

 

[CABenefits]

I moved a group under 10 from Anthem on a Solution 3500 deductible to a self funded 2500 deductible with Starmark. We added a few more benefits and premiums were nearly the same as Anthem's renewal. The reason they moved was because their broker discouraged them from leaving Anthem even though Aetna and Shield had some viable options. The broker also moved them out into left field without a gap plan option.
The entire group is healthy and no one uses drugs. About $700 each month is going into the claims account. They have almost $2000 set aside and the funds have not been touched.
If it blows up it will take 2-3 employees maxing their out of pocket. Or a cancer case...
If it does blow up we'll go back to fully insured. Starmark is a major contender and the service is great

Mike