JULY / AUGUST 2015        
PCORI Fee Reporting Supplied to Client Groups

The ABS Client Services team recently completed the distribution of Patient Centered Outcomes Research Institute (PCORI) fee reporting to client groups.

The reporting packages included group census counts (determined by snapshot method), IRS instructions and forms.

Review a copy of the client letter here.


Self-Funding Health Care Benefits Becoming a Financially-Savvy Strategy for Groups of All Sizes


Previously an attractive option for only certain large groups, self-funding of health care benefits has now become a feasible best-option for all group sizes given the new post-PPACA rate climate.

Rate increases associated with Metal plans, combined with PPACA taxes and fees, are driving the cost of group health benefits high enough for most employers to seek an alternative--for which self-funding is ideally suited when combined with stop-loss insurance to limit the employer's financial exposure.

Self-funding of group health benefits eliminates certain PPACA taxes and fees, and delivers rates which are based upon the specific group's experience rather than the "pool" based Metal plan rates, and this can result in considerable savings during a group's first year.  What happens, though, in subsequent years when stop loss rates are based on the group's experience and claims may be high?  The rates for the self-funded coverage will also increase-- but at percentages which may not be as much as insured coverage, or which may not deliver year-over-year savings, but deliver a financially-favorable solution long-term.

In the July 12, 2015, CFO magazine article Are Smaller Companies Poised to Self-Fund Health Care?,  several CFOs, including Luigi Buffone of Avatar Corp., chimed in on their transition to self-funding and the bottom-line results:
"Staying with regular insurance was going to mean a 20% to 30% premium increase for us in 2014," says Luigi Buffone, CFO of specialty-ingredients maker Avatar Corp., a company with just 60 employees that is additionally hampered in the health-insurance arena by its relatively older workforce.  "So our broker included a self-insured option.  We went with that, and our costs only went up 2%."

Avatar's health costs are up significantly more than that this year, by about 15%, because "two or three" costly claims last year triggered a steep hike in the company's stop-loss premiums for 2015.  But that increase "is less than it would have been if we'd been in a fully insured product," says Buffone.

An additional benefit of self-funding health care for groups of all sizes is that it delivers employer control over plan design and employee health data in order to implement outcomes-based wellness programs. Author Nelson Griswold in a July 8, 2015 Employee Benefit Adviser article entitled Why Self-Funding is About More Than Just Savings, stated that this control benefits not only the employer and employees, but eventually  the entire population

With this plan information merged with employees' biometric data and properly analyzed and used to drive appropriate clinical interventions, employers can begin to manage employee health to both prevent costly health issues and reduce health care utilization. And with access to individual employee health data, effective employee incentives such as premium differentials are possible. This employee population health management is the only proven method of truly bending the health care cost curve.

ABS provides self-funded plan administration for large employers, and sister company US Health and Life Insurance offers turnkey self-funding for small to mid-size employers via its SafeGuard program.  For more information or for a group quote, select a link below or contact us.
New Help
in Choosing the Right Surgeon

Two new, unrelated search tools were recently made available to the public which promise to make elective surgery planning easier and more transparent.

Additional details are available from
and CNN.

Access the databases

Growing Opposition to Proposed PPACA "Cadillac Tax"

Opposition to the proposed excise tax on generous health plans gained momentum recently with the formation of a coalition to fight the ACA provision.  

The newly formed lobbying group, called the Alliance to Fight the Forty, includes large employers, business groups, numerous pharmaceutical companies, insurance plans and unions.  Their combined effort to repeal the tax has been gaining bipartisan support.

The 40 percent "Cadillac tax," scheduled to go into effect January 1, 2018, would apply to employer-based health plans with benefit values above $10,200 for individual coverage and $27,500 for family coverage; every dollar above these thresholds would be subject to the non-deductible tax.  Both insured and self-funded coverage will be impacted by this legislation.

Read more from The Hill and Business Insurance.

ABS / USHL Self-Funding Program Information and Quoting

Self Funding for the Large Group:

Self-Funding for the Small to Mid-Sized Group:

Sales Support
 ABS Sales Support Hotline
(844) 828-5968
Sue LaCavera
(800) 229-2210 x 139
Sales Support Team Mailbox

Donna Sulhan
(800) 229-2210 x 119

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