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January 2024

A Guide for Employers: Navigating the Self-Funded Health Plan Spectrum of Solutions for Employee Benefit Programs

With numerous components to consider, it’s vital to clearly define your goals for your employee benefit plan.

Embarking on the journey to self-fund (aka self-insure) your health plan is a strategic move that offers a spectrum of choices, from pharmacy options to network arrangements, wellness programs, medical management, and beyond. With this abundance of choices, where do you begin? The key to making informed decisions lies in assessing your tolerance for risk, understanding your plan goals, and partnering with the right guide. Let’s explore how these elements play a crucial role in shaping a great employee benefit plan and why expert support is paramount.

Determining Your Tolerance for Risk

Assessing your organization’s risk tolerance can help frame your decision-making in developing your health plan strategy. Are you open to innovative options like network alternatives or do you prefer more traditional health plan designs? What is the company’s appetite for change? Consider factors such as financial stability, employee demographics, geography of employees, and historical health care utilization. Expert guidance can provide insights into risk mitigation strategies and align your choices with your organization’s risk profile.

Understanding Your Goals

With numerous components to consider, it’s vital to clearly define your goals for your employee benefit plan. Are you prioritizing cost control, employee flexibility, or a proactive approach to wellness? What are your organization’s immediate needs and long-term goals? Understanding your objectives will serve as a compass, guiding your decisions across pharmacy, network arrangements, wellness initiatives, medical management, and more.

A Great Benefit Plan Starts with Expert Support

Building and managing a self-funded health plan requires expertise in diverse areas. Relying solely on internal resources may lead to oversight and missed opportunities. Employers are experts on their people and their business, finding a partner to support and guide a self-funded health plan is important.

Whether it’s identifying opportunities to improve the employee experience, crafting a comprehensive wellness program, or optimizing medical network arrangements, support from a team of experts will help you develop a phased approach, ensuring that each element is implemented strategically and aligns with your broader benefit plan strategy.

The world of self-funded health plans can be complex and nuanced, leaving you feeling like you are conducting an experiment. But when it involves your money and your people, there’s not much room for trial and error. Navigating through the myriad of options requires expertise and a deep understanding of the industry.

Embarking on the self-funding journey is a significant step towards creating a customized, cost-effective, and employee-centric benefit plan. But a great benefit plan doesn't happen in isolation—it requires a dedicated partnership. At Nova, we believe the best solutions are built together. Learn more about the spectrum of customizable solutions available in a self-funded benefit plan.