Claros Analytics Launches Redesigned Website

Princeton, NJ – May 2024  Claros Analytics, the healthcare industry’s premier actuarial software firm, is excited to announce the launch of its redesigned website. The redesign aims to improve the user experience and make it easier for website visitors to learn how Claros Analytics’ solutions can help them advance their business through better insight into […]

Self-Funded vs. Fully Insured

Employee benefits plans can be broken out into two structures: the traditional fully insured plan or the self-funded plan. In a fully insured plan, a group purchases insurance by paying a premium to an insurance carrier. The carrier then covers all claims incurred by the plan members. In a self-insured (also known as self-funded) plan, employers pay for the claims themselves. They usually work with a third-party administrator (TPA) to process claims and often incorporate stop loss insurance to protect themselves from large claims. They may also add additional services to promote employee well-being, manage pharmacy benefits, or otherwise improve upon the components of their benefits plan. Another option not covered here is a level-funded plan. Read our blog post on level-funded pros and cons to understand this self-funded plan design that feels similar to a fully insured plan for many plan sponsors.

Self-Insured Plans 101

How do self-funded health plans work?
The self-insured plan sponsor directly pays for claims as they occur. This is often done through a designated fund for healthcare costs. Most plan sponsors will incorporate stop loss insurance to protect themselves from large claims and work with a third-party administrator (TPA) or insurance company to handle claims administration. They also determine all components of the health plan such as the plan design (employee cost share, plan network, network pricing) and what benefits are covered. Sponsors may also choose to incorporate additional components and services including pharmacy benefit management (PBM), employee wellness programs, benefits dashboards, and other programs to make their self-funded plan their own and provide added benefits.

Level-Funded Health Plan Pros and Cons

Level-funded plans have been rising in popularity in the past few years. According to The Kaiser Family Foundation’s 2021 Employer Health Benefits Survey, the percentage of small firms that report having a level-funded plan has been steadily increasing since 2019.

Level-funded plans are attractive to many employer groups because they strike a balance between the risky but rewarding self-insured plan and the steady but pricey fully-insured health plan.

Claros Analytics Launches Web-based Application for Self-Funding Feasibility Analysis

Princeton, NJ – August 2023 — Claros Analytics, the healthcare industry’s leading actuarial software firm, has launched a new web-based application that simplifies the plan structure comparison process and unlocks advanced capabilities to facilitate plan choice for those advising employer groups. ClarosRisk allows users to quickly and easily determine the cost and risk associated with […]

Client community launch, industry news, product updates, and more! 📣

Client Community: ClarosConnect We are thrilled to announce our new client community: ClarosConnect! ClarosConnect makes it possible to join with other Claros clients across the country for networking, problem-solving, and industry discussion. If you are an existing Claros client and would like to join ClarosConnect, you can do so here. Watch a Demo of Our […]

Optimizing stop loss coverage, rising healthcare costs, conference recaps, and more in our latest newsletter.

Industry News Roundup Optimizing Stop Loss is an Opportunity for Benefits Advisors —Stop loss insurance is a critical component of a successful self-funded health plan. This article explains the benefits of optimizing your stop loss coverage: applications make it easy to see the risk and reward of different stop loss structures so that each group […]

Claros Analytics Launches Web-based Application for Health Plan Analysis

Princeton, NJ – September 2022 — Claros Analytics, the healthcare industry’s leading actuarial software firm, has developed a new web-based application that simplifies designing and pricing employer health benefit plans. ClarosPlan guides users through the process of defining a plan and determining the impact of changes on overall plan cost. The application can assess a […]

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