Self-Insured Group Benefit Plans

Self-Insured Group Benefit Plans

Group insurance benefit plans provided by employers are usually one of three types: fully insured coverage, where the employer pays a monthly premium to an insurance company to assume the risk of paying out employee claims; self-insured or “self-funded” coverage, where the employer assumes the risk of paying out employee claims as they arise, thus avoiding the high cost of monthly insurance premiums, or a combination of self-insured benefits where some of the benefits are paid by the employer and some are paid by an insurer. The decision to self-insure depends on the employers’ bottom line and their employee claim patterns. Self-insuring also allows the employer to tailor its coverage to the needs of its workforce and industry.

Self-Insured Companies

Self-insured companies may choose to administer and adjudicate claims internally, hire a third-party administrator to take care of those processes or hire an insurance company to provide administrative services only (ASO).

Some employers may choose to self-insure only some of the benefits, such as health, dental and short-term disability claims. They will then contract an insurance company to assume the risk and responsibility of long-term disability claims.

If your claim has been denied and your employer is self-insured, you may be confused about your legal rights. Contact an experienced disability insurance lawyer to discuss your options.

our office and put our experience to work for you. We offer free consultations and there are no fees unless we win.

We have recently settled cases with Canada Life, RBC, Manulife, Liberty Health, Teachers Life, London Life and many more.

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