Self-Funding Plan Options

Higher Levels of Choice and Control

With self-funding, midsize (101-300 eligible employees) and large (300+) employer groups can gain greater control of healthcare costs and manage benefits investments as part of their business. Self-funding is an option for employers who want more financial control, flexible plan design, and can take on risk.

Self-funded plans can be customized based on utilization and experience that caters to the specific health needs of the employee population. Self-funded plans are not subject to state-mandated coverage requirements, so employers can offer uniform, tailored benefits to all employees, regardless of the state in which the employees are located.

The benefits of self-funded plans administered by Blue Shield of California include:

  • Access to one of the largest PPO provider networks in California, with competitive discounts. Employees enjoy broad access to care and services.

  • Enrollment and eligibility assistance to help implement plans smoothly.

  • Customer service, claims adjudication, and responsive support, all backed by robust technology.

  • Reporting and strategic services that help project claim costs, track trends, and find opportunities for benefit plan and service efficiencies.

  • Management of medically appropriate, cost-effective health care for complex conditions.

  • Pharmacy management that combines cost-cutting with comprehensive customer service.

  • Dedicated teams that deliver a full range of everyday services and expert account management.

Self-funding options include:

Administrative Services Only

An administrative services only (ASO) arrangement means an employer pays for health claims, and Blue Shield of California handles the administrative tasks, which include billing and claims processing. Advantages of an ASO arrangement include:

  • Instead of premiums, the employer pays an administrative fee and funds claims through a claims account as they are incurred; and

  • Employers can hold their own claims reserves, which allow them to gain investment opportunities.

Mitigate Risk with Stop-Loss Insurance

Stop-loss insurance* provides protection from unexpected high-dollar claims, mitigating risk associated with self-funding plans.

Large groups selecting a self-funded medical plan arrangement from Blue Shield of California may purchase stop-loss insurance from Blue Shield Life.

Midsize groups selecting a self-funded medical plan arrangement from Blue Shield of California are required to purchase stop-loss insurance from Blue Shield Life.

*Underwritten by Blue Shield of California Life & Health Insurance Company (Blue Shield Life).