Health Insurance Industry Explained... Learn the Fundamentals of Employer-Sponsored Health Plans:

A. The Healthcare System for Employers Has 4 Parts:
1) Employers, 2) Employees, 3) Providers, 4) Insurance Carriers
Understand Their Inter-Relationships

B. Health Insurance Has 2 Forms of Risk-Transfer for Employers:
1) Fully-Insured and 2) Self-Insured
Understand Credibility and Specific/Aggregate Stop-Loss Coverage

C. Network Discounts:
1) Repricing, 2) Contract Methodologies, 3) Medical Coding

D. Administrative Services Only (ASO) and TPA Services:
1) BUCA Carriers, 2) Carrier-Owned TPAs, 3) Independent TPAs

E. Health Insurance Captives:
1) Pooled Risk, 2) Adverse Selection, 3) Death Spiral

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