Self Insured

xDeb Lalani
Medical Coding
February 4, 2011

Self-Insured Plans

The costs of health care are increasing every year, which makes having an affordable health care plan essential. Self-insured plans are becoming more popular for both employers and employees, especially for larger companies. According to an article in the National Health Policy Forum,   “In 2009, 57 percent of covered workers were enrolled in a partially or fully self-insured health plan.” (#1) A self-insured employer is responsible for paying claims individually instead of prepaying for standardized coverage through an insurance company.   Because self-insured plans follow federal regulations (ERISA), state health insurance premium taxes and compliance with state health regulations are avoided. (#1)This is a major advantage over fully insured plans because if the company operates in several states, the insurance coverage and guidelines will remain the same.
Among the plans that self-insured employers offer, the PPO is one of the most flexible, with many advantages for employers as well as employees. Preferred Provider Organization (PPO) is a comprehensive health-care plan offered to corporate employees that allows them to choose their own physicians and hospitals within certain limits. The PPO benefit option offers the insured more choices of providers with fewer restrictions on coverage than other insurance options.   The providers within the network of a PPO offer discounted rates to self-insured employers which saves the company and employee money.   Another advantage is people who already have a primary doctor prior to being covered under a PPO plan; they won’t have to switch doctors if their provider is not in the network.   Many people with pre-existing conditions or chronic illnesses choose PPO’s
PPO’s are a great option because of their flexibility and wider range of providers, as long as the insured is within the network. If choosing a provider outside of the network, the employee is...