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A self-funded plan has fixed components similar to an insurance premium; but in contrast, the self-funded plan pays the claims incurred by the plan participants, and the employer's risk is not capped. Even with stop-loss insurance, the employer still retains one hundred percent of the risk of claims payments in a purely self-funded scenario.
Silent PPOs typically do not make referrals, but provide access to the discount after the service was rendered. Additionally, providers argue that, had the patient not entered via a back-door arrangement, they would not have been given the discount applied to the contract. Thus, the provider loses money from the amount that would have been charged.
GEHA (Government Employees Health Association) is a self-insured, not-for-profit association providing medical and dental plans to federal employees and retirees and their families through the Federal Employees Health Benefits program and the Federal Employees Dental and Vision Insurance Program (FEDVIP).
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An emerging model of direct primary care involves the medical practice contracting with self-insured (or self-funded) employers who offer the direct primary care option as a means of accessing care for free or drastically reduced office visit fees. This is also known as onsite health. The employer pays the membership fees on behalf of the ...
Self-insurance is an alternative to any type of insurance including home, auto and life, but the legal and financial ramifications of choosing to self insurance are very different depending on the ...