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Fully insured vs self-funded health plans – which one is right for your company?

Posted January 05, 2022 by Steve Chrzanowski, Director, Group Retention & Sales Support

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The people you hire to work at your company have diverse healthcare needs. For this reason, health insurance coverage can be a make-or-break issue for prospective employees. People who are healthy may gravitate towards a plan completely different than someone with an underlying health condition. No single healthcare plan will fit everyone’s requirements. When shopping around for group coverage, look for an insurance provider that offers a variety of plans with different features and price points.

Understanding what a provider network is and how it works will help you narrow down your group plan options. Provider networks are made up of physicians, other providers, labs, pharmacies, hospitals or medical facilities that are considered “in-network” and will provide care at a discounted/contracted rate. When employees choose to seek care outside of this group, it is considered “out-of-network” and will cost them more.

Different types of plans

Fully insured plans extend access to healthcare providers through both the SummaCare contracted network and affiliate PPO (preferred provider organization) networks - minimizing out-of-pocket costs for your employees when participating providers are used. Plan options include standard PPO and high deductible plans. Customized plans built to your specifications are available for groups with 51 or more eligible employees.

With standard PPO and qualified high deductible plans, employees can choose the plan that best fits them when it comes to copay, coinsurance, deductible, out-of-pocket maximum and prescription drug plan.

Self-Funded plans allow companies typically with 100+ employees to focus on their business while SummaCare manages and administers their benefit coverage both inside and outside the 20-county service area. In addition to medical, dental and vision plans, as well as customized plans unique to your business, SummaCare can also design plans that integrate medical, pharmacy and medical management. Some of the products and solutions we offer include:

  • Integrated health and wellness services including disease management, wellness services, case management, utilization management and large case management
  • Pharmacy benefit management
  • Stop loss/reinsurance coverage
  • COBRA administration
  • Flexible Spending Account (FSA) administration
  • Subrogation

The Chamber Health Benefits Plan is a self-funded option that gives employers with 50 or fewer employees the opportunity to join other small businesses in a multiple employer welfare arrangement (MEWA). MEWAs allow companies to share the healthcare costs of employees, which in turn reduces group plan costs, allows for better benefits options for staff, and financial protection against unexpected claims costs.

Employers can select among 18 benefit plans, including PPO and HSA-compatible plans featuring pharmacy coverage and four SummaCare networks, including The Preferred Choice Network,which is a high quality, cost-competitive network comprised of Summa Health, Cleveland Clinic, including Cleveland Clinic Akron General, and Akron Children’s Hospital.

To participate, employers need to be a member of the Greater Akron Chamber or join at the time of enrollment. Companies must be located in one of the following Ohio counties: Ashland, Ashtabula, Carroll, Columbiana, Cuyahoga, Erie, Geauga, Holmes, Huron, Lake, Lorain, Mahoning, Medina, Ottawa, Portage, Sandusky, Stark, Summit, Trumbull, Tuscarawas and Wayne.

Questions about which product is right for you?  Interested in a quote?

A benefits consultant will work with you to determine the product that best suits your budget and employees’ needs. For more information, call 330.996.8955.