Go Back   The Insurance Forums > Insurance Discussion > Health Insurance

Reply
 
LinkBack Thread Tools Display Modes

  #1 (permalink)  
Old 06-26-2007, 12:18 AM
? Sherry ? ? Sherry ? is offline
Junior Member
 
Join Date: Jun 2007
Posts: 1
Default Company changing to self-insured health insurance questions?

The company I work for was bought out, the new company offers a SELF-insured health plan that the employer pays out the claims. I know that it is through Aetna as the administator of the plan and it is a POS plan. Can anyone tell me the way a self-insured plan works and what are the drawbacks? I am worried that I am not going to have the coverage I did with my current HMO plan.


Reply With Quote

  #2 (permalink)  
Old 06-26-2007, 12:19 AM
mbrcatz17 mbrcatz17 is offline
Senior Member
 
Join Date: Apr 2007
Posts: 628
Default

Well, you're going to have to compare the coverages! Even the self insured plan should have a sheet to show you what they are covering, at what rate.

The biggest drawback is, of course, that they aren't an insurance company - so that if you have a massive claim (chemo treatments, for example, or a preemie newborn) there isn't any guarantee that the money will be there to pay it. MOST employers have a "stop gap" type plan in place, where an insurance company would pick up all claims over, say, $100,000.

The biggest bonus to it, is they aren't limited by state law in what they can cover. Or what they have to cover. And if the company is a large company, they've probably calculated that it will save them a lot of money to do it this way, which means you'll likely have more broad coverage.
Reply With Quote

  #3 (permalink)  
Old 06-26-2007, 12:19 AM
Ronna <ronnad1975> Ronna <ronnad1975> is offline
Junior Member
 
Join Date: Jun 2007
Posts: 1
Default

Self-insured plans are exactly that - they are funded by your employer. Since it is a point of service plan (POS) you will have more flexibility than you did with your HMO. With your HMO you have to use the provider that you have chosen within the network and you can be very limited. With a POS you can go to any Dr that you want at any time and have any service done (of course you will have to pay for copays and coinsurance). There are drawbacks if your employer is small and suddenly stops funding the plan - but if you work for a reputable company this shouldn't be a problem.
I would much rather have a POS plan than an HMO - I think you will see the benefits as well.
Reply With Quote

  #4 (permalink)  
Old 06-26-2007, 02:31 AM
Custo Custo is offline
Junior Member
 
Join Date: Jun 2007
Posts: 5
Default

Honestly, MOST group health plans are now self-funded. The potential exists for your benefits to be as rich as before, potentially more. Check the plan documents, are your copays more or less? How much do you pay a month? Does the new plan cover the same services? Office visits, outpatient surgery, inpatient hospital, pharmacy, physical therapy, mental health, home health, medical equipment??? Check it out.

Fundamentally, the only real difference is this.... Your new company doesn't have to follow state laws regarding health insurance coverage. The old company does.
Reply With Quote

  #5 (permalink)  
Old 06-26-2007, 02:40 AM
murrayc murrayc is offline
Junior Member
 
Join Date: Jun 2007
Posts: 5
Default

I am sure they will have a comparable plan. Most self insured companies have a company like Aetna administer it. They also have "Stop-Gap" insurance for any catastrophic illnesses (usually over $100,000).
Reply With Quote
Reply


Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

vB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are On
Pingbacks are On
Refbacks are On


Similar Threads for: Company changing to self-insured health insurance questions?
Thread Thread Starter Forum Replies Last Post
My health insurance company is cancelling my policy because my company did not pay... terri doesn't know Health Insurance 4 06-19-2007 11:36 PM
What questions should I ask in shopping for apartment rental insurance in Florida? Beanie Renters Insurance 1 06-13-2007 02:49 AM
is it cheaper to have my car and home insured by the same company or not? yassine Home Insurance 0 05-07-2007 03:45 PM
Are your pets insured? What company do you recommend? sparkleythings_4you Pet Insurance 5 04-13-2007 12:59 AM
As an insured driver of a motorcycle, can I drive my boyfriend's insured car? Alicia S Motorcycle Insurance 3 04-12-2007 03:30 PM



All times are GMT. The time now is 12:00 AM.

Powered by vBulletin® Version 3.6.5
Copyright ©2000 - 2008, Jelsoft Enterprises Ltd.
SEO by vBSEO 3.0.0 RC8 ©2007, Crawlability, Inc.