Self-Insured Major Medical Insurance

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 optimize the selection of an individual stop-loss attachment point. 

We specialize in IBNR studies for self-insured major medical plans, offering accurate estimation, financial forecasting, reserving optimization, trend 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. 

Davies has deep experience helping self-insured employers understand the financial impact of utilizing 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.  

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. 

Our consultants use the Monte Carlo simulation approach for medical stop-loss optimization. We have developed proprietary tools to assist employers who self-insure their group major medical plan to optimize the selection of a specific stop-loss attachment point.  We also can analyze potential aggregate stop loss options that are available.   

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.