|Criteria||# of Private Employers||Proportion of US workforce||Total Employees 2019||% covered by self-insured plans||Total on self insured plans|
|#Ers >1000 Ees||23,139||0.362||84,243,192||0.91||69,079,417|
|# Ers w 500-999 Ees||18,645||0.125||13,714,500||0.82||11,245,890|
|# Ers 101-499 Ees||126,647||0.125||13,714,500||0.25||3,428,625|
|#Ers 50-100 Ees||169,239||0.289||31,707,924||0.13||4,122,030|
|Notes on sources|
|Metrics for % covered on self-insured corporate plans from Health and Human Services, US Gov|
|Job metrics drawn from Bureau of Labor Statistics, US Gov|
|The total number of jobs in the US in 2018 was 156 million, the estimate above is for 2019|
|US added 1,716,000 jobs in 2019, using an average growth of 143,000 jobs per month|
|All other category uses an average 20 employees/firm to estimate total employees|
|Total employees covered on any type of employer medical plan in 2018 was 156,500,000|
|Metrics for employees covered on employer plans drawn from Kaiser Family Foundation.org|
Crib Notes on Self-Insured Plans
Self-insurance consists of four basic components, payment of claims, reserves for claims incurred but paid after contract year-end or termination, administrative fees, and re-insurance for claims which exceed an agreed threshold. Under self-insured plans, only losses beyond the targeted stop-loss provision, say $100,000 for an individual claim are paid by a third party, known as a re-insurance company. So, the employer, even firms with as few as 50 employees, must pay medical claims for all of their employees from their cash flow and the contributions the employees make to the program. To many employees these self-insured arrangements look like insurance plans, because they include participation in a preferred provider network of clinicians, probably a managed RX plan, and issue identification cards. For additional information on how these insurance plans work read Chapter 16-Insurance 101 in my guidebook to the US healthcare system (link found at the end of this article)
How Do I know If My Company Medical Plan is Self-insured?
- Name of the re-insurance company- as this will allow you to look up the financial rating of this third party that is liable for payment of large medical claims above the stop-loss level your employer has chosen. You can review Standard and Poor’s or Moody’s to assess the financial status of this company.
- Find out what the stop-loss level is for your employer’s plan, in other words, when does the re-insurance company start to pay the claims rather than your employer-if it is a lower limit, that means your employer is conservative and not assuming much risk. If the ceiling is high, then it means your employer is assuming more risk for claims payment directly. In today’s terms stop loss levels at or below $100,000 per individual claim are considered conservative, but for small firms this may not be conservative enough.
- Once you see the total claims paid for enrollees on the Summary Plan Description (SPD) you can then gauge the “risk level” your employer has taken with the claims it is responsible for versus the third-party insurance company. Conservative companies have lower risk-levels, because they are paying a higher premium up front to transfer some of the risk for claims payment.
- If you have had a surgery or major medical expense recently you will have current information on the cost of healthcare and you can gauge how much your specific claims impact the total shown for the company for the plan year.
- If your employer has a benefits committee and you want to influence benefit plan decisions, try to get on the committee.