Presbyterian Health Plan, Inc. provides Administrative Services Only for employer groups with typically 100 or more employees who decide to fund their own healthcare benefit plan. Self-funded benefit plans allow employers to take control of their company's employee healthcare coverage, both in the design and funding of the plan.
Employers who choose self-funding can achieve cost savings through:
- State premium taxes, which usually run from 2% to 6% of premium in fully-insured programs, do not apply to most elements of self-funded programs.
- Not all Affordable Care Act (ACA) fees are applicable to self-funded programs.
- Investment earnings, which accrue (usually tax-free) in the employer-established health trust, are available to fund plan expenses.
- Potential freedom from costly state-mandated benefits.
- Developing custom benefit plan designs and contribution schedules
- Plan costs are based on your group claims experience, not pooled with any other groups.
Presbyterian provides local servicing of your self-funded insurance plan
Presbyterian is locally owned and operated - which means all member services, claims processing and enrollment processing are conveniently coordinated here in New Mexico by our local service team.
Presbyterian offers a full range of administrative services for self-funded plans including:
- Plan Document Preparation Benefit Plan Design & Materials Preparation Claims Processing Services
- Comprehensive Network Access
- Utilization, Disease and Case Management Services
- Member Services
- Marketing Services
- Finance Information Technology Support
Stop Loss Coverage
Aggregate and Specific Stop Loss coverage can be provided through multiple insurance carriers or underwritten by Presbyterian Health Plan.
Fees can be calculated either on a Per Member Per Month (PMPM) or Per Employee Per Month (PEPM) basis. Fees are determined by the size of group as well as administrative services requested.
To discuss the advantages of self-funding and Presbyterian's Administrative Services, consult with the Presbyterian Sales department: