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The Top Advantages of Transitioning from Fully- to Self-Insured

Today’s employers struggle to effectively and efficiently manage the investments in their most valuable resource: their people. In an effort to maximize their investments and measure their impact, a common tactic employers are implementing is swapping their fully-insured plan with a self-insured plan. When done correctly, the switch from fully- to self-insured can be the single most effective method of containing healthcare costs.

Springbuk and Self-insured Plans:

What does it mean to be self-insured?

In a self-insured plan, employers operate their health plan - as opposed to purchasing a fully-insured plan from an insurance carrier. They also take on the financial responsibility of their employees’ benefits claims and expenses. The insurance company manages the payments, but the employer is the one who shoulders the cost.

Employers benefit from self-insuring because it allows them to cash-flow the fees that an insurance company adds to its premium for a fully-insured plan. However, self-insuring exposes the company to more significant risk if an employee files more claims than expected.

The expenses from excess claims can add up quickly. To mitigate this, employers will often invest in what’s called “stop-loss” insurance. This insurance shifts the financial liability back to the insurance provider if employee claims and expenses rise above a certain deductible.

Self-insured employers will lean on additional entities to help them arrange and manage their healthcare plan, including:

  • A Broker/Consultant: When planning their self-insured plan, an employer may consult a broker to help design different insurance plan options for their employee population.
  • Health Insurance Captive: Also known as medical stop-loss insurance, captives are organized as independent insurance companies. They are managed – either directly or indirectly – by the business or group of businesses they insure. Captives can be used by self-insured employers to provide medical stop-loss coverage to protect the plan from specific or aggregate stop-loss coverage.
  • A Stop-Loss Insurance Carrier: An employer will work with a stop-loss carrier to safeguard their organization against catastrophic claims.
  • A Third Party Administrator (TPA): An employer will bring in a TPA to administer the plan, provide healthcare customer service, process employees’ medical claims, and advise preferred networks of hospitals, clinics, or doctors.
  • A Health Intelligence platform: A unified solution that provides actionable recommendations to more strategically design and manage employee benefits to manage current and forecasted costs.

What impact will a self-insured plan have on employers?

Organizations that switch to self-insured plans are empowered to craft a healthcare plan that fits the specific needs of their population and influences their overall healthcare spend. Other typical advantages of adopting a self-funded plan include:

  • Manage Costs: Employers can avoid fully-funded associated costs, including insurance premiums, carrier fees, and premium state taxes.
  • Control of Plan Design: Instead of being under a one-size-fits-all blanket policy, employers can tailor their healthcare plan to meet the needs of their employees.
  • Better Understanding of Healthcare Spend: With direct access to historical data claims and expenses, employers can better understand and forecast their healthcare spend.

Three Ways Springbuk is Helping Brokers Use Data to Drive Decisions for Self-Insured Employers:

Springbuk’s Health Intelligence platform is empowering brokers to provide direction from a single source of truth for their clients. Our user-friendly platform can be accessed at any time, by users with any level of technical expertise. Now you and your clients don’t need to be data experts to be an expert on your data. Springbuk provides you with an unparalleled level of support to turn your data into direction.

Containing Costs, Not Coverage:

When switching from fully- to self-insured, creating plans that will have a meaningful impact on your employees’ health can be a tough task. Especially when in today’s workplace, attracting top talent is more than just offering attractive salaries. Employers need competitive compensation offerings and health solutions to ensure they secure and retain the best employees. However, when you’re stuck wading through data and trying to find direction, it can be challenging to unlock the potential of your health management system.

Springbuk’s Health Intelligence platform takes brokers and employers beyond data warehousing and healthcare analytics. Our platform does the heavy lifting for you by automatically identifying members within your employee populations who are at risk of developing health conditions. Through curated strategies, our platform equips you with the knowledge to understand what to do next to improve the health outcomes in your population. And by knowing which issues are most prevalent and costly for your members, you will be able to strategically design, implement, and sustain your health management investments through targeted opportunities.

Forecast Health Conditions:

Employers often lack the actionable information necessary to help their disease management coordinators engage directly with members at risk of future diseases. Health Intelligence tackles the employer problem by predicting conditions at the member-level. Springbuk Insights empower brokers, employers, onsite clinics, and wellness vendors to quickly build focus populations at-risk of conditions, and more effectively guide members to appropriate treatment, disease management resources, and risk mitigation strategies. When building out your new self-insured plan, Springbuk’s Health Intelligence platform provides you a single source of truth when looking at your entire population. You can see at-a-glance members who are at-risk for health events to look ahead and forecast health events.

Custom Reporting:

If brokers and employers are serious about managing their population’s health, traditional reporting won’t cut it. Now, with Springbuk Report Builder, you can more efficiently dig deeper into your data and can be tailored to show what's important to you, and your audience:

  • Quickly apply the same report to different populations or different time periods without having to screenshot or duplicate work.
  • Show visually appealing and informative reports in every client meeting, leadership meeting, or simply take a quick pulse on your health plan regularly.
  • Quickly create, download, and share reports to answer client questions such as, “Why do our drugs cost so much?” or “What’s going on with my diabetic population and where can I make the biggest impact?”
  • Add a custom cover page, changing the primary color and adding your own logo.

The right platform eliminates busywork like manual reporting and frees your team’s resources to focus on what matters most: driving lasting improvements in the health of your employees.


Ready to see how the power of Health Intelligence can help maximize the investment in your health management system? To request a personalized walkthrough, visit http://springbuk.com/request.