Certificate in Self-Funding Group Health Plans
Employers
that sponsor a group health plan for their employees may choose to
self-fund the plan instead of purchasing health insurance. This means
that the plan sponsor retains the financial risk and pays for all health
claims out of specifically reserved funds or general business assets.
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
The Certificate in Self-Funding Group Health Plans is best suited for:
- 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.
Following the successful completion of an online certificate, students will be able to apply their knowledge in the field and gain valuable experience. Students will also be well-prepared to further apply their learning by attending face-to-face International Foundation programs and earning their Certified Employee Benefit Specialist (CEBS) designation.