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What you need to know about self-insurance

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

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.

Employer Service Center

For groups headquartered in Minnesota, North Dakota, South Dakota and Wisconsin:

For groups headquartered in Iowa and Nebraska:

Monday – Friday: 8 a.m. to 5 p.m.
Closed 8 a.m. to 9 a.m. Thursdays

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