Self-Funded Health Plans in Bloomfield Hills, Explained Plainly
Many growing employers feel stuck. They pay a high premium every year and never learn where the money went. That frustration is why many owners and HR leaders start asking about self-funded health plans in Bloomfield Hills and across Oakland County.
We are an independent employee benefits consulting firm, in business since 2007. We help you decide whether self-funding fits your company. If it does, we find, set up and oversee the partners who run it.
Self-Funded Health Plans
In a self-funded plan, the employer pays employee medical claims as they happen, instead of paying a fixed premium to a carrier. The technical term is “self-insured.” A third-party administrator, or TPA, processes the claims. Stop-loss insurance protects you from very large claims or a bad year.
CFH is not a TPA. Our job is to help you pick the structure, compare administrators and stop-loss carriers, and hold the administrator to its contract. We review the claims reports with you and explain what they mean in plain words.
Self-funding lets you see your own claims data. You can shape the plan design. You may keep money that is not spent in a good year. But your costs can swing more from year to year. It is not the right fit for every company.
Self-funded plans also carry federal ERISA duties, such as plan documents, notices and filings. We help keep you ERISA compliant. Form 5500 and the PCORI fee are due by July 31 for calendar-year plans that must file.
Is my company big enough to self-fund?
There is no single cutoff. In Michigan, a group of 50 or fewer employees is small group, and rates come from carrier filings, ages and ZIP codes. Above 50, your own claims start to count. That is the range where many employers begin to look at self-funding. Smaller groups often look at level-funded plans first, which are a gentler step.
Ask yourself a few questions. Can your cash flow handle a month with high claims? Is your workforce fairly steady? Do you want to see your data and act on it? If the answers are yes, self-funding deserves a closer look.
What is the difference between self-funded and fully insured?
With a fully insured plan, you pay a set premium and the carrier takes the risk. You get little data back. With a self-funded plan, you pay claims, buy stop-loss protection and get your data. A level-funded plan sits in between the two.
Common questions
Do employees lose their doctors if we self-fund?
Not always. Many self-funded plans use a carrier’s network, so employees can often keep the same doctors. We check this with you before you decide. The check covers the doctors and hospitals your people use most, and anyone mid-treatment or expecting a baby, since those are the cases where a network difference matters right away. If a narrower network is part of the savings, you see that before you sign.
Who helps employees with claim problems?
The administrator processes claims. Our customer service team helps employees when something goes wrong and presses the administrator for an answer. That includes finding out whether a denial was a plan decision or a processing error, and when a plan decision is disputed, making sure the appeal reaches the plan with the right record attached.
Can we go back to a fully insured plan?
Usually, yes, at a renewal. We plan the exit with you, including how late claims will be paid. The run-out matters because claims incurred before the switch keep arriving for months and are paid by the self-funded plan, not the new carrier. Stop-loss terms matter here too, since some policies stop covering claims paid after the contract ends.
Talk to us about self-funded health plans in Bloomfield Hills
Send us your renewal or book a 30-minute call. We will tell you honestly whether self-funding makes sense for you. Visit us at 41000 Woodward Avenue, Suite 350 East, Bloomfield Hills, MI 48304, or call 248.370.8853.
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