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.
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.