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Reply to Small Group Options for 1099 Employees     
Old 08-31-2017, 07:13 AM   #11
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Small Group Options for 1099 Employees Re: Small Group Options for 1099 Employees
Originally Posted by leevena View Post
A good point to be made. But if you construct the plan correctly, including a time limitation on when claims need to be filed, your example will be a non-issue for the employer.
I used to think that however, a COBRA eligible group per federal law is primary with Medicare and per federal law, the employer would eat the claim. This happened on a large fully insured group and we simply dropped it on the carrier. Stop losses would have run out unless they had a 12/36 or 48 contract.

One reason HDHPs were so good for individuals isn't that you get a spec = the EE out of pocket and an agg = the family OOO.

Another issue with self funded isn't no carrier isn't required to offer a renewal and can exclude coverage on a particular insured.

We also had an employer in financial trouble that went ASO against our recommendations because they could hold the reserves. The problem came when the contract ended. An ASO contract is for 12 months with monthly payments. They couldn't renew because the plan ended and they had no one to administer the run out.

Another company with young employees bought administration and a network with no stop loss at all - not even an agg. They ran fine - until they didn't. "Didn't wiped out more than they saved.

People selling self funded say "If it's set up right" or "almost never happens".

Insurance is statistics and we are a random variable. Be careful and understand what you have (and sell).
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Old 08-31-2017, 11:48 AM   #12
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Small Group Options for 1099 Employees
Originally Posted by junkman View Post

I used to think that however, a COBRA eligible group per federal law is primary with Medicare and per federal law, the employer would eat the claim. This happened on a large fully insured group and we simply dropped it on the carrier. Stop losses would have run out unless they had a 12/36 or 48 contract.

One reason HDHPs were so good for individuals isn't that you get a spec = the EE out of pocket and an agg = the family OOO.

Another issue with self funded isn't no carrier isn't required to offer a renewal and can exclude coverage on a particular insured.

We also had an employer in financial trouble that went ASO against our recommendations because they could hold the reserves. The problem came when the contract ended. An ASO contract is for 12 months with monthly payments. They couldn't renew because the plan ended and they had no one to administer the run out.

Another company with young employees bought administration and a network with no stop loss at all - not even an agg. They ran fine - until they didn't. "Didn't wiped out more than they saved.

People selling self funded say "If it's set up right" or "almost never happens".

Insurance is statistics and we are a random variable. Be careful and understand what you have (and sell).
Thanks for that, I do not remember ever having a situation like that. Have a good day.
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Old 09-01-2017, 06:46 AM   #13
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State: junkman is an Insurance Agent from Tennessee
Small Group Options for 1099 Employees Re: Small Group Options for 1099 Employees
Originally Posted by leevena View Post
Thanks for that, I do not remember ever having a situation like that. Have a good day.
Now ACA rates are so bad that I'm considering for some husband/Wife client's that are getting hammered on rates. They have the highest OOO available and it's still high.

I'll have to find the source but a couple plans have come calling. There would be no tax penalty and these people can handle the high deductible. Next year options are unknown regardless of what plan they have.

This is about keeping friends covered. Individual health is not a revenue stream in TN.
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