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.