What type of management is typical for self-insured health plans?

Self-insured health plans typically use a third-party administrator (TPA) for claims processing. This arrangement allows the self-insured employer to delegate the administration of health plan functions such as claims processing, customer service, and compliance with regulatory requirements to a specialized firm. By utilizing a TPA, the employer can focus on their core business while ensuring that claims are handled efficiently and in compliance with applicable laws. TPAs are equipped with the expertise and resources necessary to manage the complexities that come with health insurance claims, making them integral to the successful operation of self-insured plans.

In the context of self-insurance, many employers opt for this model to gain greater control over their healthcare costs and risks, and working with a TPA provides the operational capability to manage these plans effectively. The use of a TPA does not eliminate the employer's responsibility for funding claims; rather, it enhances the management of those claims, ensuring that employees receive the medical services they need while also facilitating the employer's financial strategy related to health benefits.