Medical Self Funded Schemes
Self funded schemes are schemes where no form of cover is purchased, but rather the employer sets aside a fund for payment of medical expenses incurred by staff members and their dependants.
Eagle Africa administers the client’s fund at a pre-agreed management fee.
Scheme benefits and limitations (rules) are determined by the employer and this makes the scheme more flexible.
Expenditure is spread out throughout the year rather than upfront payment of premium where the policy is insured.
In times of good claims experience savings would be realized.
Why a self-funded plan?
Your company provides health benefits to your employees with your own funds. Some of the advantages include:
- You can customize your employees’ health benefits.
- Fewer state regulations.
- Potentially lower costs for you and your employees.
- Pay as you go or by claim projections made weekly or monthly.
- Plan payouts are based on your group’s claims experience, not a pooled or community group.
- More detailed reports about how your health care dollars are being spent.
Here's a comparison between self-funded and fully-insured plans.
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Self-funded Schemes |
Fully-insured Schemes |
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An administrative service company collects from your company then pays doctors and hospitals for claims. |
Your health insurance company pays doctors and hospitals for claims. |
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You pay the administrative service company a fee to manage your self-funded program. |
You pay your health insurance company an annual premium for each employee contract. |
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Claims cost can vary from week to week. |
You pay the same premium no matter what your employees' individual claims are. |