Self-Insured Major Medical Insurance
Empowering participants in the self-insured major medical market
We support self-insured employer groups, small group captive programs & more. Our self-insured major medical insurance areas include premium equivalent rate development, incurred but not paid studies, reference-based pricing analysis, multiple employer welfare arrangements, medical stop loss optimisation, and broker and third-party administrator support.
Self-Insured Major Medical Insurance
What we offer
Premium Equivalent Rate Development: Davies has extensive experience developing premium equivalent rates for employers who self-insure their group major medical plan. This work can incorporate changes in plan designs, provider network changes, and pharmacy benefit managers. We also can help employers optimise the selection of an individual stop-loss attachment point.
Incurred But Not Paid (IBNR) Studies: We specialise in IBNR studies for self-insured major medical plans, offering accurate estimation, financial forecasting, reserving optimisation, tend analysis, risk management, regulatory compliance, and claims management insights. By partnering with us, self-insured employers can make informed decisions that ensure the long-term financial sustainability of their primary medical plans.
Reference-Based Pricing Analysis: Davies has deep experience helping self-insured employers understand the financial impact of utilising a reference-based pricing (RBP) reimbursement approach for their self-insured group major medical plan. The savings opportunities are large, but many nuances must be understood when considering an RBP approach.
Our consultants can quantify the potential savings opportunity from using an RBP reimbursement approach and consult with employers to help them fully understand the range of issues related to an RBP approach.
MEQA Actuarial Support: Multiple Employer Welfare Arrangement (MEWA) actuarial support is crucial for these group healthcare plans’ financial stability and regulatory compliance. MEWAs allow employers, often in the same industry or region, to pool their resources to provide employee benefits.
Our MEWA actuarial support includes financial analysis and reporting, contribution rate development, reserve adequacy analysis, stop-loss coverage evaluation, regulatory compliance, underwriting and risk assessment, and strategic consulting.
Medical Stop Loss Optimization: Our consultants use the Monte Carlo simulation approach for medical stop-loss optimisation. We have developed proprietary tools to assist employers who self-insure their group major medical plan to optimise the selection of a specific stop-loss attachment point. We also can analyse potential aggregate stop loss options that are available.
Broker & TPA Actuarial Support: We have significant experience providing actuarial support to insurance brokers and third-party administrators (TPAs) who serve employers who self-insure their group major medical plan. We have experience working with employer groups of all sizes.
