Self Funding

Primarily for employers with over 50 employees on their health plan, self-funded plans offer the ability to control health costs, customize plan designs and reduce tax liability. Self-funded plans are able to capitalize on savings earned throughout the year instead of the fully insured plan provider reaping the benefit. Professional Benefit Services offers self-funded administration of medical, dental and/or vision plans with a full suite of offerings to support each product.

Benefits Overview

With the continuous rise in health plan expenses and services, many service providers are taking action to increase margins by cutting services and increasing indirect compensation. This prevents clients from fully understanding the variables influencing their plan and inhibits their ability to participate in improving the offering. At Professional Benefit Services, we value the experience of our clients and want to include them in the process to the level they choose to be involved. Professional Benefit Services’ emphasizes transparency of services, high-level customer service, and innovative cost containment strategies in health claims management to deliver a high-quality product customized to each client.

We work with our clients to ensure the appropriate vendor is working with their plans to ensure the client’s goals are met. Revenue sharing (kickbacks) is removed from our provider contracts or credited to the client to ensure our motivations align with our client’s goals. This transparency is critical in allowing effective evaluation of vendors and the best fit for each client. Additionally, we are always open to working with new service providers as the space is ever-evolving.

Why consider a self-funded plan?

  • Reduce Costs (Potential Cost Reduction of 30% or More!)
  • Employer has opportunity to capitalize on good plan year (low claim loss)​
  • Out-of-network savings can be attained reducing overall cost
  • Less taxation than fully insured plans (minimum of 2% ACA tax savings on premium alone, states add another 1.75% on average)
  • Small employers (<100 FTE’s) utilizing self-funded medical are not subject to community rating requirements
  • Self-funded plans are not subject to the Essential Health Benefit (EHB) Requirements which allows plans to exclude certain types of coverage that fully insured plans cannot

Who is currently using self-funded medical plans?

  • Employers as small as 50 employees with stable claim history
  • Employers that desire flexibility and customization from their health plans
  • 61% of all employees were covered by self-funded/partially self-funded plans, compared to 44% in 1999

What we do

  • Networks: Coordinate with existing PPO, secondary and wrap networks and/or assist in selecting these networks.
  • Pharmacy: Coordinate with current PBM (Pharmacy Benefit Manager) or establish a new relationship. We can work with any PBM.
  • Medical Management: PBS has existing relationships with multiple medical management vendors that allow us to find the best fit for your situation.
  • Customer Service: We have a full customer service department to support your members and providers. Additionally, we offer a website to members, providers, and employers that provide information on every claim, plan document information, deductible satisfaction, temporary ID cards, etc…) This website is integrated with our Alegeus website for clients with an FSA, HSA or HRA with us for Single Sign On capability.
  • Document Design: We will map over an existing health document or work with you on drafting a new document. We put the control back in your hands with the ability to draft the plan how you want it.
  • Reporting: We can supply you with various reporting options to assist with managing your plan.
  • Continuous Improvement: We work with your advisor to recommend changes to your plan depending on your goals. If cost is top priority, we may make suggestions regarding plan design or plan features (i.e. medical tourism, telemedicine, wellness, etc…) to help you achieve your goal.

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Reasons to Self Fund

A self-funded plan is one in which the employer group takes the place of the insurance company and assumes the financial risk for providing health care benefits to its employees.

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Professional Benefit Services – Self Funded Health Administration

Innovative cost containment solutions are critical in today’s healthcare environment.

Let’s Talk Benefits.

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General Inquiries

(800) 982-2012