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5 Important Actions For Your Self-Funded Plan

The COVID-19 health crisis has been difficult to navigate, especially for self-funded employers. The pandemic’s impact on your self-funded plan is daunting.

Understanding these challenges and the financial implications is pivotal to the long-term health plan success. Developing a corporate strategy for your benefits program is critical.  To assist self-funded clients, here are 5 things you need to consider for your plan:

1.Contact your SISCO Account Manager to initiate a plan amendment. The FFCRA and Cares Acts include mandates for covering expenses related to COVID-19 testing at no cost-share to members.

  • Benefit changes outside of the current mandates, like expansion of telemedicine, furlough/layoff provisions, or COVID-19 treatment, require amendments.
  • At a minimum, SISCO recommends adding telemedicine to all health plans to drive cost savings and reduce risk of COVID-19 exposure.

2. Understand stop loss implications. Most stop loss carriers are agreeing to mandated plan requirements without negative rating impact. However, any plan changes outside of federal mandate or large enrollment changes can affect stop loss.

  • Many stop loss carriers reserve the right to re-rate stop loss in the event of a dramatic enrollment change (>10%) in workforce.
  • If you are looking at a large reduction in your workforce, now or in the future, connect with your SISCO Account Manager so we can work with you and your advisors to navigate the stop loss cost implications.

3. Don’t reduce your claim reserves. While many states and providers are putting a temporary hold on elective procedures, it is unwise to alter claim reserves based on current declining claims volume. Reducing the claim reserves now because of the current trend will lead to funding shortages in the future.

4. Ensure pharmacy benefits are available to support your staff. SISCO will work with your Pharmacy Benefit Manager (PBM) to ensure 90-day mail order availability to reduce cost and ensure continued availability for members. We will also ensure PBMs are allowing early fills when necessary.

5. Understand the financial impact to your plan. SISCO’s COVID-19 Cost Estimation Tool examines the possible cost to your plan based on enrollment and average costs of COVID-19 testing and treatment. Your SISCO Account Manager can share the cost impact related to your plan with you.

These are uncertain times, but we are here to help answer your questions. Contact your SISCO Account Manager to help develop a plan to address COVID-19 impact to your health plan.