Your Employee's Predicted Health Care Costs

There are well established statistical (i.e. actuarial) guidelines for determining the most statistically likely health care needs and related costs for any given individual or group of individuals. As part of the pre-qualification process to become an MCM Maxcare client, we will interview you regarding your employees' demographic profile and their loss claim history from your previous health insurance plan(s).

We will provide this information to the third party underwriter who will provide a quote for the stop/loss coverage on your self-insured plan which will cap your maximum outlay for health care costs over your plan's duration.

Your Tolerance for Risk

One of the first questions we get from organizations unfamiliar with the mechanisms of a well-designed self-insurance plan is:

"What happens if my organization has above average health care costs? Doesn't that cost us more money than if we had chosen a traditional health insurance company or an HMO?"

Not only is the answer no, it does not cost more, but in some cases even with higher than expected health care costs, your organization may still come out ahead.

One of the key components of a well-designed self-insurance plan is the acquisition of third party underwriting for stop/loss coverage. In other words, MCM Maxcare assists you purchasing an insurance plan that only kicks in after some monetary cost threshold is met.

So after looking at your employee's projected health care costs and measuring the cost-benefit ratio's of a variety of stop/loss thresholds, MCM Maxcare will help you determine your tolerance for risk. Obviously, if your organization has a higher tolerance for risk, your cost threshold for the underwriting will be higher - exposing you to potentially greater costs - but your premium for the underwriting will be lower. Conversely, if your organization has a low tolerance for risk, your cost threshold for the underwriting will be lower - reducing your vulnerability to higher health care costs - but your premium for the underwriting will be higher.

Making Your Plan Work for Your Organization

Once these determinations have been made and you've implemented your self-insurance plan, its important to remember that your success is directly tied to your ability to communicate and otherwise motivate your employee participants to use doctors and facilities within the MCM Maxcare PPO network. By staying in network as much as possible, your employees will enjoy savings on their health care costs which directly translates in savings on your organization's health care costs.

Learn more about the pre-qualification process to become a client of MCM Maxcare...