Partial Self-Funding

RT Health & Life's Group Division utilizes partial self-funding in providing medical, dental, vision and short-term disability insurance coverage. Partial self-funding allows for a much lower employer base cost when compared to fully insured or HMO plans. The employer then participates in claim costs up to an agreed-upon maximum.

Advantages of Partial Self-Funding

• Allows for "favorable risk" pricing
• Provides detailed claims information to aid in plan design and pricing
• Frequently provides significant cost savings over fully insured and HMO plans
• Claims reserves are under employee control
• Creates maximum flexibility and customization

Generally, the employer is provided cost (risk) management in three ways, as follows:

1. Specific Stop-Loss Coverage

Specific insurance limits the employer claim expense to a specific dollar amount, per year/per person. For groups under 100 employees, the maximum cost is usually $10,000- $20,000, but a much higher limit can be elected.

2. Aggregate Stop-Loss Coverage

Aggregate insurance limits the employer cost for the total of all claims for all employees for the plan year. Most often, this is a very manageable cost for the employer. Specific claims in excess of the specific stop-loss (e.g., $10,000) are not calculated in the aggregate total, as they are paid by the specific excess-loss coverage.

3. Monthly Aggregate Accommodation (optional)

In addition to the protection of the specific and aggregate stop-loss coverage, the Monthly Aggregate Accommodation provides the employer with a monthly cap on claims.