On 10/7/2015 9:00 AM, Cindy Hamilton wrote:
> On Wednesday, October 7, 2015 at 7:57:42 AM UTC-4, Gary wrote:
>>
>> It's not just his co-workers on the same policy, it's all the people
>> worldwide that use the same company and don't claim much. Insurance
>> companies make a fortune overcharging everyone for health insurance.
>> Some customers develope large and expensive health problems and they
>> win. Most people pay each year and don't claim much. They pay for the
>> sicker ones.
>
> Not exactly. His company is self-insured. There's an outfit that
> administers claims, but the company pays the claims directly, out
> of the pool of money that is filled up by the premiums that they
> and we pay.
>
> Cindy Hamilton
>
>
Yep, self-insured plans are a different animal. There is usually
reinsurance which will kick in when the self-insured retention (SIR)
hits a certain level (say, $200,000 in claims). Often additional
reinsurance is added on top of that, generally only for very large
companies), known as aggregate coverage. And yes, a third-party claims
administrator handles the processing. (I've worked for a couple of TPA's.)

Jill