Self-administered plans

[Guest Lisa Nieman]

I work in the Human Resources dept. of a group of healthcare specialists. We currently have a TPA administering our health/dental/STD claims. I would like to explore the possibility of administering our own self-insured plan. I have 4 1/2 years of experience in running a self-insured, self-administered plan but I need some particulars of how other companies have started their own and how it runs, etc. Is there anyone out there who is doing that type of plan? I am well aware of the risks as the feasibility was constantly questioned when I worked at the other self-administered plan but it saved us a ton of money in administration costs. I'd appreciate any information or comments. Thanks.

[Guest gjdavid]

My firm has been self-administering medical,dental and STD claims for over 25 years. I have found, like you, that cost savings is real and defensible. It has really been a plus for our organization from an employee relations standpoint.

There are a number of factors to consider carefully including;

The number of employees you would be administering claims for. We self-administer for approximatley 3,400 employees. I have seen a few plans with less than 1,500 but in these cases there are typically reasons other than cost that they continue to self-administer.

Management support of the concept. You nor management will be able to point a finger at a TPA when employees become unhappy with claims turnaround or customer service. Employees will point their fingers at you and you will need management to help insure employee relations don't suffer.

Patient Management is another important point. Because of the capital requirments payback will probably not come for three to five years. In many companies that simply won't fly.

I would be happy to share specifics. Just let me know.