SELF FUNDED GROUP PLANS
A self funded group health is just that. Funded by the employer. Make any design you choose because the employer plan is not asking an insurance company to offer a plan and pay premium for it. When the insurance company is not involved the employer has the freedom to tailor make the plan as they wish but they need a TPA (Third Party Administrator) to administer enrollments and claims which the employer typically cannot do or doesn’t have the expertise to do. The employer pays a small fee per employee for the administrative services and the employer pays all claims out of their own cash flow. This is why self funding is reserved for larger entities with good cash flow and strong reserves. The same effect can be accomplished by smaller firms by buying large deductibles such as $25,000 to $75,000 to pay the large claims a medium employer might not be able to handle with ease. You will need a competent advisor to analyze whether your firm is a good candidate for self funding.