A South Carolina corporation, it is the national Third Party Administrator (“TPA”) platform that allows AIMS to provide a complete turn-key package for any employee benefit system, including claims management, premium billing, and multi-product management – all with best-in-class management reporting. Through the HIPAA-compliant internet portal, www.abmsusa.com, employees and management have access to enrollment, reporting and many other segments of this system that will also interact with the medical providers under contract for benefit plans. This cloud-based system is supported by partnerships with industry leaders that will ensure its support and integrity.
ABMS is managed by Randy Wright, a 30 year veteran of the TPA market and highly respected by his peers and the brokers he deals with.
The healthcare and insurance marketplaces are extremely volatile today. We are witnessing skyrocketing healthcare and prescription charges leading to fewer and fewer fully-insured carriers in the market and subsequently larger rate increases on in-force group health coverage. This volatility is just one of the many reasons an enormous number of companies are choosing to explore self-funding as an option for their employees’ healthcare.
Reasons to Choose Self-Funding:
There is a probability of cost savings for an employer. An employer saves money when a plan’s expenses (claims experience) are less than expected. At the same time, the employer is protected in the event that the plan’s expenses are greater than expected.
- There are no state premium taxes (usually 2-3% of monthly insurance premiums) since a self-funded plan falls under Federal (ERISA) jurisdiction.
- The employer has greater flexibility in plan design under ERISA Federal jurisdiction. This allows the employer to design an individual benefit plan focusing on employees’ actual needs and potential cost savings.
- Risk charges, contingency reserves and higher retention charges that insurance companies apply are eliminated.
- Interest income is earned and retained by the employer on health reserves (money remaining after claims have been paid). Reserves can be held in an interest-bearing trust account, producing tax-exempt interest.
- Employers can improve cash flow because coverage is not pre-paid. Insurance premiums are due in advance, whereas self-funded plans pay claims as they are submitted to the plan administrator, usually 60- 90 days after medical service is received.
- The expenses associated with a self-funded plan are based on the histories of the organization’s employees, not based on any other employee population. There is no pooling with other employers;
- Employers are protected against significant claims expense through stop-loss coverage. Employers are protected in two ways. First, specific coverage protects against a single catastrophic claim that exceeds a dollar limit chosen by the employer and agreed to by the stop loss carrier; and
- Secondly, aggregate coverage protects an employer against all the claims exceeding a specific dollar limit agreed to by the employer and stop loss carrier. In each case, an employer can choose the right dollar amount based on their willingness to accept risk and/or cost of coverage.