Self-Funded Health Insurance 101

Introducing: A realistic approach to employee health benefits

Now, you can gain control of your health care expenses while providing quality benefits to your employees. By combining the cost savings of self-funding with the stability of more traditional plans, our Self-Funded Insurance Program gives you the simplicity and cost savings you’re looking for without the hassle of administering the program yourself. National General benefit Solutions are a national leader in the self-funded health insurance space. Our teams of experienced professionals are ready to provide you and your agent with group market expertise,  immediate access to support, quick resolution of issues, and hands-on help at the time of reissue.

Simple. Safe. Savings.

In the Past, self-funded health insurance used to be a concept only available to large employers. Not anymore. Business owners like you enjoy the advantages of self-funding. And now, with our Self-Funded Program, you get to experience those advantages without taking on added risk. It’s an easy way for you to lower your costs while providing quality health care benefits for employees.

Key Advantages of a Self-Funded Health Insurance Program:

Predictable monthly payment

  • Your monthly payment is determined upfront and guaranteed not to increase for a full year as long as there are no changes to your group’s benefits or enrollment.

Plan administration and account management

  • Payments of claims, customer service and reporting is all done for you, leaving you to focus on your business.

Quality benefits

  • All employer-established benefit plans are minimum essential coverage
  • Preventive services are paid at 100% when received from in-network providers, as recommended by the Affordable Care Act

Are you overpaying for group health care benefits?

Where do your premium dollars really go? With fully insured health plans, your entire premium is paid to the insurance company. You don’t have any control over how that money is spent. You won’t see any of those premium dollars again, even in years when your group’s claims are less than expected.

Our Self-Funded Insurance Program is different. Some of your monthly payment is used to run the daily administration of your plan, but portions of it are also used to pay your stop-loss insurance premium and to build your claims account. In years when claims are lower than expected, a portion of the difference between your group’s anticipated and actual claims is credited back to you — and that adds up to significant savings.

We make it easy for you to put a self-funded health benefit plan to work for your business

Here’s how it works, for your everyday convenience, this plan behaves just like a more traditional, fully insured health benefit plan. You provide your level, monthly payment, and we handle the details. The difference lies in where your premium dollars go. We manage your program to make sure you get the savings and simplicity you need by splitting your premium among the program’s three components. 

The Self-Funded Program’s Three Components 

Plan administration.

A third-party administrator handles the day-to-day functions of the program. Our third-party administrators will:

  • Manage claims payments
  • Provide reporting to help manage costs
  • Handle your group members’ customer service needs

Stop-loss insurance.

When your group has higher-than-expected claims, stop-loss insurance kicks in to protect your finances. Stop-loss insurance:

  • Protects your finances from higher-than-expected claims
  • Helps you limit your business’s financial exposure

Claims account.

Money used to pay claims incurred during the coverage period. Your claims account:

  • Holds the funds needed to pay employees’ claims
  • Is protected from larger-than-expected claims with stop-loss insurance
  • Depending on the plan selection you make, if claims are less than anticipated, we will either refund a portion of the difference between the balance of your claims account and your group’s actual claims, or you can receive that amount in full*

Your business. Your plan.

We provide health benefit plans with features your group will actually use. Although not all benefit options are available with every plan, we provide several flexible options to help you select the plan designs that will benefit your group the most.

  • Deductible options range from $500 to $7,900 (availability varies by state).
  • Coinsurance options: 100%, 90%, 80%, 70% and 50%
  • Multiple office-visit copay options
  • Health Savings account (HSA) and Health Reimbursement Arrangement (HRA) options available and vary by third party administrator.
  • Access to large, national networks, with discounts for using in-network doctors and hospitals
  • Prescription copay options available
  • Teladoc®: A convenient and valuable telehealth service that can save money for both you and your members. (not available in WA)
  • Preventive care coverage aligns with Affordable Care Act requirements
  • COBRA administration
  • Urgent-care and emergency-room copay options
  • First-dollar diagnostic x-ray and lab options

For More Information

For more information regarding self-funded health insurance please contact Next Generation Payroll a local black-owned business in Dallas. We provide services that are designed to create a level playing field that allows local businesses to thrive in a global economy. In other words, our services are centered around risk management, operational efficiency, and strategies that improve market penetration by improving business opportunity leads. We build up small businesses making sure your business is solvent, and it operates efficiently in all economic climates.

At Next Generation Payroll, we are not interested in fulfilling quotas and meeting monthly sales goals. We focus on goals that are centered around fulfilling our client’s aspirations. Our top priority is to simply provide a strategy to help your business reach full potential. For more information, feel free to reach out to us at 214-396-2200. Stay in touch with us by signing up below for our monthly updates and newsletters. 


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