Great question! I’ll explain this one by first referencing the self-funded structure. In it, health claims receive a lot of attention. They’re not just processed and pushed through with a “paid” stamp. They’re scrutinized by the plan’s third party administrator (TPA) and when a charge, code or anything else seems out of whack, the billing party is questioned.
Employers make sure employees understand this. They encourage them to play a part in controlling claim expenses by being involved in all aspects of the care process and learning how to make smart decisions with their health dollars.
Educated employees can impact the cost of claims (and potential savings!) by knowing where to get quality care at a reasonable price. As part of a self-funded plan, they often have access to tools that help simplify things like choosing specialists, getting pre-authorizations and finding top-rated facilities.
On top of education, employees can affect savings by taking part in wellness initiatives. These are a common feature in self-funding as employers realize that one of the most effective ways to keep claim costs down is to keep employees healthy. When employees have opportunities for things like risk assessments, health coaching and incentive-based challenges, they are more likely to focus on wellness. This can ultimately reduce the chance for pricey claims.
There are a lot of savings scenarios that can come from something as simple as employee engagement. Get a closer look at the topic in our Cypress Series article: “Top 3 Advantages of Self-Funding: Advantage #3 – Employee Engagement.”