Self-Funded

Is a self-funded plan right for you?

As employee health care prices rise, many companies are looking at new ways to take control of these costs. Self-funded plans are an alternative that can reduce costs while providing plans tailored to employees’ needs.

Self-funding is on the rise. Fifty-nine percent of companies in the United States self-fund their plans.

No longer just for large corporations. Self-funded plans from The Health Plan can cover companies with as few as 25 employees.

Control costs. Pay medical claims as incurred or deposit expected costs each month. After the claims are paid, keep the year-end difference while stop-loss insurance protects from catastrophic claims. 

Personalize your plan. Mimic the structures and benefits of your current plan, or build a custom plan to fit your company. 

Protect your plan. THP can secure stop loss for your self-funded health plan so employee claim cost does not exceed expected claim amount.

Access to national PPO networks. As a trusted third-party administrator, THP gives access to a wide variety of respected doctors and hospitals.


Self-Funded Benefit Options

Claims Administration

The Health Plan has certified coders, registered nurses, and clinical technicians to review and process claims. We accurately and efficiently process claims, in excess of 1.6 million a year, consistently with established benefit structures. We accept both electronic and paper claims. Within 24 hours, 100 percent of our claims are paperless. THP has the ability to administer any pricing methodologies: Reference Based Pricing, Medicare Based Pricing, DRG, Bundled Payments, Fee Schedules, Usual & Customary Rates, etc. 

Customer Service

We take great pride in our customer service abilities. Our customer service standards exceed the average five percent industry standard. Over 95 percent of the time, we will resolve any problem on the first call. All calls regarding benefits, claim issues, and eligibility by specific product line are answered quickly by a dedicated professional in one of our office locations. Our integrated systems allow customer service staff to view information such as benefits, claims history, correspondence, and eligibility information to resolve issues quickly. We also document all forms of participant contact in our systems as they are received and closed once the issue is resolved.

Network Services

The Health Plan network services team is NCQA accredited. We have a dedicated national account manager, and full-time provider relations education and service representatives. With access to over 650,000 national and regional providers, our capabilities include a national transplant network, high dollar claims negotiations, and custom network development.

Transplant Policy
The Health Plan offers a fully-insured transplant policy to transfer the risk for transplant coverage to a fully insured contract and protect your stop loss and claim fund. This plan provides a predictable expense for very unpredictable conditions with high cost and high variability. Typically quoted upon request.

Telehealth

The Health Plan’s telehealth program, powered by HealthiestYou, gives members exclusive access to a physician to discuss signs and symptoms of illnesses at any time of the day or night simply by picking up a phone. We are simplifying an employee’s health care experience for most minor illnesses and bringing the MD to them with the largest telehealth network in the country that uses board-certified, licensed physicians.

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