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Self-Insured Plans

Self-insured plans are no longer just for large groups. Many employers consider self-insured plans as a way to better manage their health care costs, control their health benefits, and minimize their short and long-term plan expenses. Taxes and assessments can be significantly lower for a self-insured plan than for a fully insured plan.

What are the differences between fully insured plans and self-insured plans?

If you’re new to self-insurance, there are several differences from a fully insured plan, including: 

   Fully Insured
Medical Plans
 Self-Insured
Medical Plans
 Monthly Cost  Paid as a fixed monthly premium Payment of monthly administrative
 fee (fixed costs) and claim
costs (variable costs) 
 Regulatory Oversight  State  Federal
 Regulatory Compliance  Shared responsibility between Employer and Medica Employer responsibility 
 Plan Privacy Shared responsibility between Employer and Medica   Employer responsibility
 Claim Appeals and Reviews  Medica  Employer appoints Medica to serve as named claim and appeals fiduciary


What are the options for self-insured plans?

There are several plan options for employers looking for a self-insured health care plan.

Traditional Plans

Many large employers, generally with more than 100 eligible employees, choose to self-insure with Medica. We offer significant flexibility in plan design, product and provider network. 

Monthly Accommodation Plans

Employers with more than 50 eligible employees now have the option to self-insure with Medica. Employers choose from a broad array of plan designs. Specific and aggregate stop loss coverage offers financial protection against claims variability. 

Maximum Liability Plans

Employers with 10 or more eligible employees can also self-insure with Medica. With similarities to a fully insured plan option, employers get the benefit of predictable monthly payments offered through a choice of several plan designs. 


Traditional Monthly
Accommodation
Maximum
Liability
Group Size   100+ eligible employees

51 or more eligible employees
(40 enrolled employees are required)

10 or more
eligible employees
(10 enrolled employees required in MN and WI.  26 eligible employees required in ND.)
Service Area
  • Minnesota
  • North Dakota
  • South Dakota
  • Wisconsin
  • Minnesota
  • North Dakota
  • Wisconsin
  • Minnesota
  • North Dakota
  • Wisconsin
 Plan Designs and Benefits
  • Customized plan designs
  • Multiple plans can be offered
  • Choose from several plan designs.
  • Up to 6 plans can be offered
  • Choose from several plan designs
  • Up to 6 plans can be offered
 Networks
Varies by state Varies by state Varies by state
 Health and Wellness Programs

Includes My Health Rewards by Medica®, health management programs, and health and wellness resources. Fit ChoicesSM by Medica, Healthy Savings Fresh Produce, Medica Optum® Employee Assistance Program (EAP), and additional My Health Rewards programs are available at an additional cost.

Includes My Health Rewards by Medica®, health management programs, and health and wellness resources. Fit ChoicesSM by Medica, Healthy Savings Fresh Produce, Medica Optum® Employee Assistance Program (EAP), and additional My Health Rewards programs are available at an additional cost.

Includes My Health Rewards by Medica®, health management programs, and health and wellness resources. Fit ChoicesSM by Medica, Healthy Savings Fresh Produce, Medica Optum® Employee Assistance Program (EAP), and additional My Health Rewards programs are available at an additional cost.



What you need to know about self-insurance

Claims

With a Medica self-insured plan, employers are responsible for their claims costs.

Fees

Employers pay a monthly administrative fee to Medica for services including claims processing, customer service, network, pharmacy and health management programs. Employers are also responsible for paying the reinsurance and the PCORI (Patient-Centered Outcomes Research Institute) fees. This is different from fully insured plans where the monthly premium paid by the employer covers all health plan costs. 

Stop-Loss Insurance

Most employers with self-insured plans also choose to purchase stop-loss insurance. Stop-loss insurance offers protection from unpredictable plan losses and minimizes your overall financial risk. 

There are two types of stop-loss insurance.

  • Specific stop-loss insurance provides protection against unpredictable or catastrophic claims on any one individual. 
  • Aggregate stop-loss insurance provides a maximum on the total dollars paid by the employer during a contract period.
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