Purchased plans- According to the text, fully-funded plans require employers to pay monthly premiums and the insurance company assumes the financial risk for providing coverage to those under the plan. This means premiums are affected by a number of things such as number of employees, population characteristics AND health care use. Self-funded plans- According to the text, Self funded plans are risky because employers are responsible for paying all claims PLUS administration fees. Employers purchase catastrophic or stop loss coverage that will pay for larger claims. These plans are EXEMPT from state insurance laws, which may not seem like a big deal, unless youre a cancer patient needing certain oral chemo drugs. In the following article we learn about how self-funded plans are not always the best choice if employers truly have their employees best interest at heart. Current events article about self-funded plans: http://www.modernhealthcare.com/article/20160531/news/160539997 (Links to an external site.) Discussion: Read the above article and address the following questions: 1- As an HR professional responsible for your company's benefits, how would you go about choosing between a self-funded or a purchased plan? In your discussion post, list items you would consider and identify the pros/cons (benefits/risks) of each type of plan. Which would have a better chance of lowering costs while offering the best care for employees? 2 - You know your organization's healthcare claims are rising; however, the company's current provider (United Healthcare, Cigna, Aetna, etc) will not release the medical data to you to determine where the costs are coming from. You think perhaps if your company funded itself you could have the data and use it to control costs. What does the law say about this? Distinguish between legal and ethical issues here.

Purchased plans- According to the text, fully-funded plans require employers to pay monthly premiums and the insurance company assumes the financial risk for providing coverage to those under the plan. This means premiums are affected by a number of things such as number of employees, population characteristics AND health care use. Self-funded plans- According to the text, Self funded plans are risky because employers are responsible for paying all claims PLUS administration fees. Employers purchase catastrophic or stop loss coverage that will pay for larger claims. These plans are EXEMPT from state insurance laws, which may not seem like a big deal, unless youre a cancer patient needing certain oral chemo drugs. In the following article we learn about how self-funded plans are not always the best choice if employers truly have their employees best interest at heart. Current events article about self-funded plans: http://www.modernhealthcare.com/article/20160531/news/160539997 (Links to an external site.) Discussion: Read the above article and address the following questions: 1- As an HR professional responsible for your company's benefits, how would you go about choosing between a self-funded or a purchased plan? In your discussion post, list items you would consider and identify the pros/cons (benefits/risks) of each type of plan. Which would have a better chance of lowering costs while offering the best care for employees? 2 - You know your organization's healthcare claims are rising; however, the company's current provider (United Healthcare, Cigna, Aetna, etc) will not release the medical data to you to determine where the costs are coming from. You think perhaps if your company funded itself you could have the data and use it to control costs. What does the law say about this? Distinguish between legal and ethical issues here.