At UT Health East Texas, we offer self-funded plans that allows employers to select a plan that best fits their business.
Traditional Self-Funded Plans
Unlike a large insurance company’s one-size-fits-all solutions, our self-funded plans offer flexibility in setting deductibles, out-of-pocket maximums and covered services.
Employer groups with 100 or more employees are best suited to benefit from self-funded insurance. The employee pool is large enough to distribute the risk, and the potential cost savings are significant. Our self-funded solutions can be customized to deliver cost-effective benefits and excellent care.
- Choose your plan design. Develop a plan with your broker or account team that suits the needs of your employees.
- Choose your network. UT Health East Texas works with several provider networks to give employees a broad choice of doctors and facilities.
- Determine your level of risk. Our analysts will help you determine your attachment point, the level of which your liability ends.
- Add additional benefits. Dental, vision and other ancillary benefits can be part of your benefits solution.
- Monitor your coverage. Groups can monitor utilization in real time through the portal. Your account team can schedule reviews so you’ll know exactly where and how your money is being spent.
Level Funded Plans
Our level funded plans combine cost savings and the customization options of our traditional self-funded plan into a simplified health benefits plan called CAP Select. With CAP select, groups pay just one monthly fee that covers administrative costs, stop loss premiums and claims funding. This is a great option for small companies with 25+ employees.
- Potential surplus: If claims are lower than projected, a reserve can accrue by the end of the contract, providing companies with funds that can cover other benefit-related costs.
- Limited risk: If claims are higher than projected, extra costs are covered by stop-loss insurance, which is included in monthly premiums.
- Fewer fees: Governed by ERISA rules, plans escape many state-mandated benefits, state regulations and premium taxes that add unnecessary costs to a health plan.
- Transparency: Full access to plan’s claims experience is available.
- Flexibility: Select deductibles and out-of-pocket limits.
Minimum Essential Coverage Plans
Providing basic employee coverage does not have to be complicated or expensive. Our SimpleSelect plan is a good option for employers who do not traditionally offer benefits, such as a business with many lower-wage workers or PRN employees. It is a self-funded health plan that includes preventive healthcare. It is available for groups with at least 50 full-time benefit-eligible employees.
- Self-funded: Avoids taxes and regulations that are applied to fully insured products.
- Provides preventive care: Meets the minimum requirements by the Affordable Care Ace (ACA), including common screenings for heart problems, diabetes and cancer; routine vaccinations, tobacco cessation programs and more.
- Affordable: SimpleSelect allows employers to offer a needed benefit to employees at a cost far below the penalties that would be applied due to non-compliance with the ACA.
- Level 1: Basic plan covers preventive care only
- Level 2: Provides a greater value than typical MEC plans, with up to four physician visits annually for each participant, at a low copay; generic drug plan with a $2 copay; and unlimited access to telemedicine services.
- Level 3: Adds additional benefits, such as emergency room care.
Our dental plans use the same self-funding principles. We design and administer a self-funded dental plan that allows employer groups to offer dental benefits at an affordable cost.
How it works
In a self-funded dental plan, the employer pays only administration fees plus services actually provided. This can provide significant savings compared to a fully insured plan, since those premiums remain the same no matter how much dental care is used.
- Immediate savings. On average, a self-funded dental plan will cost about 20% less per year than a similar, fully insured plan.
- Low risk. Dental plans have a low annual limit on expenditures per person because it is not necessary to include high-cost services or hospitalization. This makes the employer risk very low. Also, self-funded dental plans do not require the purchase of stop loss insurance to cover the risk of claims being much higher than anticipated.
- Self-funded savings apply. No premium taxes, avoidance of high premium increases and better cash flow due to the pay-as-you-go approach.
- Better health and well-being. Good dental health attributes to good overall health. People with serious gum disease are up to 40% more likely to have a chronic health condition. Poor dental health is also linked to serious illnesses like diabetes or heart disease.