Self-Funding Group Health Plans Cohort

Employers that sponsor a group health plan for their employees may choose to self-fund the plan instead of purchasing health insurance. The decision to self-fund is complex and involves strategic decision-making regarding plan design, cost-containment strategies, whether to purchase stop-loss insurance, and plan administration. This online certificate includes four required courses that will review these decision points in detail.

Benefits of Earning Your Certificate

After successfully earning your Certificate in Self-Funding Group Health Plans, you will be able to:

• Explain why an employer might decide to self-fund its health plan
• Identify similarities and differences between self-funding and fully insuring health plans
• Describe the two main methods for financing self-funded plans
• Identify tools, like stop-loss insurance, that self-funded plans can use to reduce risk exposure and manage costs
• Describe key provisions of stop-loss insurance including specific deductibles, aggregate deductibles and lasering
• Identify the advantages and disadvantages of in-house administration of a self-funded plan compared to contracting a TPA or an ASO company
• Identify regular tasks that a plan administrator or service provider must perform on behalf of the plan
• Outline how self-funded health plans must comply with federal laws like ACA, COBRA, HIPAA and ERISA
• Evaluate effective cost containment strategies like data analysis, predictive modeling, provider network design, cost sharing design, utilization management, wellness incentives, surcharges and exclusions
• Improve health literacy of plan participants to affect overall plan cost.

Who Should Enroll

• Group health plan sponsors including single employer plan sponsors and multiemployer plan trustees
• Plan administrators
• Professional service providers that are new to the industry, including accountants, attorneys, actuaries, investment managers and advisors, TPAs, insurance agents, benefits consultants, and recordkeepers
• Experienced benefits professionals serving a new type of plan or considering a new health plan funding method.

Agenda