Self Insured plan cost? California

[idea0001]

What is the name of your state (only U.S. law)? California

Our union has a CBA with our company. We pay 20% of the premium for our health insurance. I pay $258.58 pre month for a HMO. It is a large company and self insured. We can not get any info from the company. We are sure that they are making money from the insurance. Shouldn't we get a rebate check? Should they be required to disclose how much they are making from the insurance?

 

[ecmst12]

That seems very unlikely, considering that would be serious fraud. Is your plan a family plan? If so, are you sure that you are only supposed to pay 20% of the coverage for your dependents? It's common for the company to pay the majority of premium for the employee, but only a small percentage for the rest of the family.

 

[cbg]

That's considerably LESS than the employees here pay...

 

[idea0001]

ecmst12, what would serious fraud? Yes it is a family plan HMO. I pay 258.58 per month which would make the monthly fee for the insurance around 1300.00 per month. It seems to me that the company should have to open their books and show the union the bottom line. If the company is making money from the insurance, union members should get a 80% rebate check on any money they make from the insurance plan.

 

[ecmst12]

$1300 for a family plan is NOT at all unheard of. Not even uncommon.

What exactly do you mean by "making money off the insurance" anyway? Both you and the company pays the insurance bill with pre-tax dollars; so if they are taking money from you and NOT turning it over to the insurance company, that's tax fraud. But there is basically no way that they are getting a family plan for less then they are charging you. Even individual plans are hard to get for less then $250.

 

[cbg]

$1300 for a family plan is, in fact, on the low side. I don't think you have a very good sense of how much health insurance costs. What has happened to make you so certain that you are being overcharged?

 

[idea0001]

Sorry, I should have been more clear.

Our company has a "Self Insured Plan" They own the insurance and contract out to a third party to run the plan. If they make money off the plan at the end of the year shouldn't we get a 80% rebate check? Our contract with the company says that we have to pay 20% of the costs of our premium.

 

[ShyCat]

No. You are not due a rebate if the company pays out less than the premiums collected that year. Would you expect to pay extra for the difference when the company pays out MORE than the premiums collected that year?

 

[cbg]

I am well aware of what is meant by a self-insured plan. The plan I was talking about is self-insured also. I promise you, they're not making any money off your premiums. They're not only paying the administrator to run the plan, they're also providing the money to pay the claims - that's what self-insured MEANS. But even if they were, that's not how insurance works, self-insured or no. You don't get a rebate if the premiums exceed the claims.

And why on earth would you expect a rebate of the full 80%? What on EARTH makes you think that the company would be incurring no costs at all?

 

[idea0001]

80% of the profits they make off our insurance. Then union membership would truly only be paying 20% of the insurance costs.

Is there any way to force the company to open their books reguarding the true costs of the insurance? Our union has been asking for info but the co. will not comply.

 

[cbg]

I ask again, why do you believe they are making a profit off the insurance?

 

[idea0001]

For the first 15 years of my employment with the company they paied 100% of our insurance costs. That was a great benifit in our contract.

The company now is only paying 80% of the benifit. I guess profit is not the right word to use. Lets look at it as a benifit from our contract. If the bottom line after everything and everyone is paied shows a plus then the union body should get a rebate.

I ask again,
Is there any way to force the company to open their books reguarding the true costs of the insurance? Our union has been asking for info but the co. will not comply.

 

[cbg]

Short of a subpoena, no, there is no way to force them to open the books. I guarantee you that they are reviewed by a third party, neutral auditor every year, as well as sending financial information about the costs to the Federal government. In fact, that report, the one to the Feds, would have gone out just within the last month or so. I forget if they're due the first of July or the end of July, but it's definitely July. If they were cheating you on the costs, the Feds or the auditors would find it.

But if they did open their books to you, I am 100% certain you would find that costs have increased, premiums that they must pay to the administrator have increased, and they are LOSING money on the insurance.

Watched the news lately? Read the newspaper? Seen anything about a recession?

 

[lkc15507]

For the first 15 years of my employment with the company they paied 100% of our insurance costs. That was a great benifit in our contract.

The company now is only paying 80% of the benifit. I guess profit is not the right word to use. Lets look at it as a benifit from our contract. If the bottom line after everything and everyone is paied shows a plus then the union body should get a rebate.

I ask again,
Is there any way to force the company to open their books reguarding the true costs of the insurance? Our union has been asking for info but the co. will not comply.

Ya know, I find this truly offensive. You have a self funded plan in which your employer actually pays the health care claims. Of course the fund should and has to profit because your and every other claimant's/participant's premiums cannot even begin to cover the actual health care costs. I'd give you a green thumb if the fund is truly profiting and then diverting those profits elsewhere. I'll kiss a goat's butt if that is truly the case. Self funded plans are governed by the US DOL. Under all kinds of statutes primarily originating from the IRS. Okie, that's a round about, but in effect you need to rethink your position. Your premiums cover your health care costs in a large employer group without that fund profiting? LOL LOL LOL LOL LOL