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Self-funded Health Care
Self-funded health care, also known as Administrative Services Only (ASO), is a self insurance arrangement in the United States whereby an employer provides health or disability benefits to employees using the company's own funds.About.com > What is a self-funded health plan?From Kelly Montgomery, former About.com Guide. Updated November 12, 2008 This is different from fully insured plans where the employer contracts an insurance company to cover the employees and dependents. In self-funded health care, the employer assumes the direct risk for payment of the claims for benefits. The terms of eligibility and covered benefits are set forth in a plan document which includes provisions similar to those found in a typical group health insurance policy. Unless exempted, such plans create rights and obligations under the Employee Retirement Income Security Act of 1974 ("ERISA"). Health plans In the United States, a self-funded health plan is generally established by an employer as i ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Self Insurance
Self-insurance is a situation in which a person or business that is liable for some risk does not take out any third-party insurance, but rather chooses to bear the risk itself. In the United States the concept applies especially to self-funded health care and may involve, for example, an employer providing certain benefits – generally health benefits or disability benefits – to employees and funding claims from a specified pool of assets rather than through an insurance company, as the term is traditionally used. In self-funded health care, the employer ultimately retains the full risk of paying claims, in contrast to traditional insurance, where all risk is transferred to the insurer. See also * Insurance * Risk management * Third party administrator * Self-funded health care Self-funded health care, also known as Administrative Services Only (ASO), is a self insurance arrangement in the United States whereby an employer provides health or disability benefits to employe ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Individual Mandate
An individual mandate is a requirement by law for certain persons to purchase or otherwise obtain a good or service. United States Militia act The Militia Acts of 1792, based on the Constitution's militia clause (in addition to its affirmative authorization to raise an army and a navy), would have required every "free able-bodied white male citizen" between the ages of 18 and 45, with a few occupational exceptions, to "provide himself" a weapon and ammunition. (See Conscription.) The Militia Acts were never federally enforced, so their constitutionality was never litigated. Seaman relief act An Act for the relief of sick and disabled seamen, signed into law by President John Adams in 1798, required employers to withhold 20 cents per month from each seaman's pay and turn it over to a Collector of the Federal Treasury when in port, and authorized the President to use the money to pay for "the temporary relief and maintenance of sick or disabled seamen," and to build hospitals t ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Insurance
Insurance is a means of protection from financial loss in which, in exchange for a fee, a party agrees to compensate another party in the event of a certain loss, damage, or injury. It is a form of risk management, primarily used to hedge against the risk of a contingent or uncertain loss. An entity which provides insurance is known as an insurer, insurance company, insurance carrier, or underwriter. A person or entity who buys insurance is known as a policyholder, while a person or entity covered under the policy is called an insured. The insurance transaction involves the policyholder assuming a guaranteed, known, and relatively small loss in the form of a payment to the insurer (a premium) in exchange for the insurer's promise to compensate the insured in the event of a covered loss. The loss may or may not be financial, but it must be reducible to financial terms. Furthermore, it usually involves something in which the insured has an insurable interest established by ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Insurance Bad Faith
Insurance bad faith is a tort unique to the law of the United States (but with parallels elsewhere, particularly Canada) that an insurance company commits by violating the "implied covenant of good faith and fair dealing" which automatically exists by operation of law in every insurance contract. In common law countries such as Australia and the UK, the issue is usually framed in the context of a failure of the duty of utmost good faith originating in English insurance law, which does not constitute a tort but rather provides the insured a contractual remedy unique to insurance law. If an insurance company violates the implied covenant, the insured person (or "policyholder") may sue the company on a tort claim in addition to a standard breach of contract claim. The contract-tort distinction is significant because as a matter of public policy, punitive or exemplary damages are unavailable for contract claims, but are available for tort claims. In addition, consequential damages ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Insurance Companies
Insurance is a means of protection from financial loss in which, in exchange for a fee, a party agrees to compensate another party in the event of a certain loss, damage, or injury. It is a form of risk management, primarily used to hedge against the risk of a contingent or uncertain loss. An entity which provides insurance is known as an insurer, insurance company, insurance carrier, or underwriter. A person or entity who buys insurance is known as a policyholder, while a person or entity covered under the policy is called an insured. The insurance transaction involves the policyholder assuming a guaranteed, known, and relatively small loss in the form of a payment to the insurer (a premium) in exchange for the insurer's promise to compensate the insured in the event of a covered loss. The loss may or may not be financial, but it must be reducible to financial terms. Furthermore, it usually involves something in which the insured has an insurable interest established by o ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Stop Loss Insurance
Stop-loss insurance is insurance that protects insurers against large claims. Stop-loss policies take effect after a certain threshold has been exceeded in claims. Overview Insurance companies themselves, as well as self-insuring employers, purchase stop-loss coverage for a premium to protect themselves. In the case of a participant reaching more than the specific (or "individual") stop-loss deductible ($300,000, for example), the insurer will reimburse the insured (the company, not the participant) for the remainder of the claim to be paid over that deductible amount. There is also typically an aggregate-claims deductible, which is applied to all paid claims combined. For all claims at or below their specific stop-loss level, if the sum of these are more than the aggregate stop loss level, then the insurer will reimburse the insured for the difference. Insurance companies and health and benefits consultants typically use mathematical models analyzing historical claims data to proj ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Financial Risk
Financial risk is any of various types of risk associated with financing, including financial transactions that include company loans in risk of default. Often it is understood to include only downside risk, meaning the potential for financial loss and uncertainty about its extent. A science has evolved around managing market and financial risk under the general title of modern portfolio theory initiated by Dr. Harry Markowitz in 1952 with his article, "Portfolio Selection". In modern portfolio theory, the variance (or standard deviation) of a portfolio is used as the definition of risk. Types According to Bender and Panz (2021), financial risks can be sorted into five different categories. In their study, they apply an algorithm-based framework and identify 193 single financial risk types, which are sorted into the five categories market risk, liquidity risk, credit risk, business risk and investment risk. Market risk The four standard market risk factors are equity ri ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Stop-loss Insurance
Stop-loss insurance is insurance that protects insurers against large claims. Stop-loss policies take effect after a certain threshold has been exceeded in claims. Overview Insurance companies themselves, as well as self-insuring employers, purchase stop-loss coverage for a premium to protect themselves. In the case of a participant reaching more than the specific (or "individual") stop-loss deductible ($300,000, for example), the insurer will reimburse the insured (the company, not the participant) for the remainder of the claim to be paid over that deductible amount. There is also typically an aggregate-claims deductible, which is applied to all paid claims combined. For all claims at or below their specific stop-loss level, if the sum of these are more than the aggregate stop loss level, then the insurer will reimburse the insured for the difference. Insurance companies and health and benefits consultants typically use mathematical models analyzing historical claims data to proj ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Discretion
Discretion has the meaning of acting on one's own authority and judgment. In law, discretion as to legal rulings, such as whether evidence is excluded at a trial, may be exercised by a judge. Some view discretion negatively, while some view it positively. Discretion exists at all levels of law enforcement and in many types of front-line bureaucrats. Discretion has been called "the Art of suiting the action to particular circumstances" (Lord Scarman). Those in a position of power are most often able to exercise discretion as to how they will apply or exercise that power. The ability to make decisions which represent a responsible choice and for which an understanding of what is lawful, right or wise may be presupposed. In law In the legal system, discretion is often defined as the ability of a judge to choose where, how and with what severity to sentence a person who has been convicted. A person chooses to utilize his or her options and decides which to use, whether this is a ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Outsourcing
Outsourcing is an agreement in which one company hires another company to be responsible for a planned or existing activity which otherwise is or could be carried out internally, i.e. in-house, and sometimes involves transferring employees and assets from one firm to another. The term ''outsourcing'', which came from the phrase ''outside resourcing'', originated no later than 1981. The concept, which ''The Economist'' says has "made its presence felt since the time of the Second World War", often involves the contracting of a business process (e.g., payroll processing, claims processing), operational, and/or non-core functions, such as manufacturing, facility management, call center/call center support. The practice of handing over control of public services to private enterprises (privatization), even if conducted on a limited, short-term basis, may also be described as outsourcing. Outsourcing includes both foreign and domestic contracting, and sometimes includes offshoring ( ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Fiduciary Duty
A fiduciary is a person who holds a legal or ethical relationship of trust with one or more other parties (person or group of persons). Typically, a fiduciary prudently takes care of money or other assets for another person. One party, for example, a corporate trust company or the trust department of a bank, acts in a fiduciary capacity to another party, who, for example, has entrusted funds to the fiduciary for safekeeping or investment. Likewise, financial advisers, financial planners, and asset managers, including managers of pension plans, endowments, and other tax-exempt assets, are considered fiduciaries under applicable statutes and laws. In a fiduciary relationship, one person, in a position of vulnerability, justifiably vests confidence, good faith, reliance, and trust in another whose aid, advice, or protection is sought in some matter... In such a relation, good conscience requires the fiduciary to act at all times for the sole benefit and interest of the one who trust ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Trustee
Trustee (or the holding of a trusteeship) is a legal term which, in its broadest sense, is a synonym for anyone in a position of trust and so can refer to any individual who holds property, authority, or a position of trust or responsibility to transfer the title of ownership to the person named as the new owner, in a trust instrument, called a beneficiary. A trustee can also be a person who is allowed to do certain tasks but not able to gain income, although that is untrue.''Black's Law Dictionary, Fifth Edition'' (1979), p. 1357, . Although in the strictest sense of the term a trustee is the holder of property on behalf of a beneficiary, the more expansive sense encompasses persons who serve, for example, on the board of trustees of an institution that operates for a charity, for the benefit of the general public, or a person in the local government. A trust can be set up either to benefit particular persons, or for any charitable purposes (but not generally for non-charitable ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
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