The NDHA Health Benefits Trust is available to all its hospital members. For more information on the NDHA Health Benefits Trust, please contact abrennan@ndha.org.

The NDHA Health Benefits Trust was established to help our members address the ever-increasing costs and challenges in providing health care benefits to their employees. Moving away from fully-funded plans, the Association and its members joined a growing number of employers making the transition to self-funded health benefit plans.

So, why are employers opting for self-funded health benefit plans?

Cost

A self-funded plan generally costs less than a fully-funded plan. It decreases expenses such as taxes on premiums and administrative costs. The profit margins added by insurance companies are eliminated.

Control

In a self-funded plan, claims are paid as they occur, whereas in a fully-funded plan, the full premium is paid regardless of actual claims. In a self-funded plan, if a substantial number of claims arise, stop-loss insurance kicks in to pay claims that exceed a certain threshold, ensuring protection for the plan.

Flexibility

Self-funded plans are not one-size-fits-all plans. Employers are not locked into off-the-shelf plans offered by insurers. Benefit plans can be optimized to meet the unique needs of employees and best suit the organization.

Transparency

More often than not, in fully-funded plans insurers keep the claims data. Self-funded plans offer more transparency into costs and claims. Members can see the big picture and, with help from the trust administrator, be more proactive in implementing wellness, prevention, and alternative care programs for their employees.

Making the switch to a self-funded plan is a smart choice for employers who want to take control of their health benefits and manage costs. Members gain access to more flexible large-group health plan rules by working together and pooling resources. They also gain improved leverage in negotiating health insurance premiums.

Transparency in Coverage Rule

The Departments of Health and Human Services, Labor, and the Treasury have finalized a Transparency in Coverage rule that requires health plans to create a patient-facing price comparison tool and post publicly available machine-readable files which include negotiated rates for covered services for in-network providers, historical payments to and charges from out-of-network providers for covered items and services, and negotiated rates for in-network prescription drugs.

Delivery of the price comparison tool is required by January 1, 2023. The requirement to produce machine-readable files containing negotiated rates for in-network prescription drugs has been delayed while the Departments work to issue additional rules governing this requirement.

Machine-Readable Files

 This regulation’s intent is to provide healthcare pricing information that will support more informed decisions for receiving care.

BCBSND will provide the following machine-readable files, formatted in a way that can be processed online:

• In-network provider rates for covered services.
• Out-of-network allowed amounts and billed charges for covered services.

BCBSND provides public access to machine-readable files that provide in-network provider rates for covered services. The information is available from the BCBSND website on the Transparency in Coverage page here.