Funding and Finance of Health Benefits
Methods for funding and financing employee health benefits are complex and have changed over time. Rising health care costs, combined with new options for self-insuring or self-funding benefits, provide an environment with many choices for decision makers to consider. This course explores the various options for funding health benefits, emphasizing how to select methods that will work best for employees and the organization. Gather with your peers and experts in the field for two days of learning best practices and real-world knowledge to help manage your organization's health care dollars efficiently. Learn what has worked for others and take a deep dive into funding, assessing and managing funds to create successful outcomes.
Topics Covered
- Pillars of financing
- Risk management
- Financing mechanisms
- Funding vehicles
- Employee contributions
- External landscape
- Self-funding
- Scenarios in transitioning from one financing type to another
- Case study
Course Outline
Day 1
- Introductions
- Pillars of financing
- Fully insured vs. self-funded
- Fully insured rating alternatives
- Self-funded administration alternatives
- Funded vs. unfunded plans
- Factors to consider for self-insuring
- Claims predictability
- Organization's/fund's finances
- Administration
- Taxes
- Plan design
- Employee population characteristics, related health care costs and cost-containment initiatives
- Employee communications and relations
- Risk Management
- Risk management spectrum
- Frequency and severity
- Financing Mechanisms
- Concepts in this section include:
- Creditability of a group
- Surplus, deficit and retention
- Reserves
- Pooling
- Advantages, disadvantages and prevalence statistics of financing options
- Future trends outlook
- Fully Insured
- Experience rated
- Premium delay
- Minimum premium
- Self-Funded
- The concept of stop-loss insurance
- Administrative services-only vs. third-party administration
- ERISA preemption
- Funding Vehicles
- General assets
- Trust
- VEBA
- Captive insurance company
- Employee Contributions
- Methodologies
- Credit and surcharge strategies
- External Landscape
- Private exchanges
- Group captive arrangements
- Affordable Care Act (ACA) taxes and fees
- Actuarial Value (AV) calculator explanation and demonstration
Day 2
- Self-Insured (The Deep Dive)
- Health care insurance food chain
- Payers
- Components of a claim
- Stop-loss insurance
- Specific, aggregate, aggregating specific
- Types of stop-loss contracts
- Pricing of stop-loss coverage
- Purchase and renewal decision points
- Expected incidence and severity rates
- Incurred but not paid (IBNP) reserves-Assessing and developing
- Setting and underwriting premium equivalent (PE) and COBRA rates
- Claims data
- Census data
- Fees
- Vendor administration
- Prescription drug rebates
- Creditability of the group
- Plan design(s)
- Health care cost trend rate assumptions
- Claims Adjudication Components
- Transitioning Scenarios
- When do you consider transitioning?
- Who provides the transition alternatives and analysis?
- What steps need to be taken?
- Case Study
In the case study, class participants are broken up into groups based on whether they represent a multiemployer or a single employer plan sponsor. Each group reads about a fictitious scenario, draws conclusions, collaborates on recommendations, and then reports their findings and recommendations back to the entire classroom.
Course Applies To
Pricing
July 16 - 17, 2025
Chicago, IL
Through June 2, 2025
US$1,400.00
Member
US$1,620.00
Nonmember
After June 2, 2025
US$1,700.00
Member
US$1,920.00
Nonmember
Pricing
May 1 - 2, 2026
Scottsdale, AZ
Through March 16, 2026
US$1,495.00
Member
US$1,715.00
Nonmember
After March 16, 2026
US$1,795.00
Member
US$2,015.00
Nonmember
Pricing
September 30 - October 1, 2026
Caribe Royale Orlando, Orlando, FL
Through August 17, 2026
US$1,495.00
Member
US$1,715.00
Nonmember
After August 17, 2026
US$1,795.00
Member
US$2,015.00
Nonmember
Continuing Education
Educational sessions at this program can qualify for CEBS Compliance credit. Visit www.cebs.org/compliance for more information.
Agenda
Wednesday, July 16 - Thursday, July 17, 2025
Chicago, IL
8:00 AM - 5:00 PM
-
Douglas Nistetter, ASA, MAAA -
Steven Draper,
Downloads
8:00 AM - 3:00 PM
-
Douglas Nistetter, ASA, MAAA
-
Steven Draper,
Downloads
Friday, May 1 - Saturday, May 2, 2026
Scottsdale, AZ
The selected event has no sessions.
Wednesday, September 30 - Thursday, October 1, 2026
Caribe Royale Orlando, Orlando, FL
The selected event has no sessions.