Self Insurance Expertise

Since Obamacare, the future of fully insured health plans is in question. The restrictions on health insurance companies, ACA requirements, plus ramifications on employers who buy fully-insured employee health coverage are driving unsustainable cost increases.

Maximize the Competitive Value of Your Employee Benefits

Sadly, insurance companies became the political scapegoat of health reform, and so, many of the reforms spotlight insurance companies for limitations & requirements that are guaranteed losers. It simply will not make sense to insurance companies and their investors & owners to lose hundreds of millions of dollars.

For example, the Median Loss Ratio (MLR) requirements will limit insurers to only 15% of premium dollars for non-medical expenses. Claims paying accuracy and service diminishes. Employers resent getting less and the extra costs as simply more expense.

States have been given millions of health reform dollars to beef up their capacity to second-guess and deny premium levels. In most cases, the level of premiums that will be approved or rejected will be influenced by politics, not actuarial or market costs. One state official described the result for insurance companies as being "a train wreck". So, insurance companies will not be able to set premiums at levels their actuaries say are needed.

Insurers are participating in state marketplaces. However, Massachusetts' existing program is the model, and the major insurance companies in that program each lost tens of millions of dollars just in the first quarter of 2010. What insurance company wants to stay in a market where they are losing tens of millions of dollars every few months?

There are more and more restrictions & disincentives for health insurance companies in health reform and the emerging regulations. It becomes an unsustainable no-win marketplace for insurance companies to continue to sell employee benefit health coverage.

What is going on is sad and unfair...but it is now entrenched, and traditional small group health insurance (under 50 employees) will disappear. On the brighter side, several years ago, several innovators foresaw the possibility of the market in the US for fully-insured health policies & plans disappearing for whatever reasons. ERISA (self-insurance) provides new opportunities for employers to craft their own group health benefits.

By definition, self-funded plans, have no profits, most have fiduciary protections, so the punitive restrictions forced on health insurance companies do not apply. Also, there is much more control & flexibility for employers to design and administer their plans for the wants & needs of each particular workforce. So, the kinds of controls, limits and governmental second-guessing are not involved.

If your goal is to find more affordable ways of providing competitive, value-based benefits; we are your partner.

We help employers design a systemic approach for making a strategic investment in employee benefits that recalibrates the allocation of existing dollars and resources to gain a greater competitive advantage.

Creating a benefits agenda/benefits business plan that identifies priorities, maps the path and delivers results for today as well as tomorrow is the key challenge for companies.

The Hettesheimer Insurance Agency delivers the consulting and analytical services needed to manage the delivery of your health care benefits. We cure medical illiteracy and improve adherence to evidence-based medicine. Disease treatment compliance improves and healthcare need is reduced. All of our solutions target 100% of your employees and their dependents. Financial and clinical outcomes are improved, reported from your healthcare data. We work as commissioned agents or on a revenue share model based on the savings we create in your health care benefit plan.


Self Insurance with a "Safety Net"
Employers with 10+ Employees

Advantages of Self-funding under the Affordable Care Act

- Self-funded plans exempt from many costly new mandates and state taxes
- Many ACA provisions do not apply to self-funded plans
- Ability to customize plan designs
- Higher probability of reducing cost & trend of medical benefit expense
- Wellness and member engagement programs have a direct impact on reducing claims costs

What Networks are Available? Many including AETNA & Cigna

Self-funding Bends the Cost-Curve & Provides Savings
Level-Funded & Self-Funded Health Plans with Integrated Wellness Administration
Integrated Wellness Administration & Incentive Management

- Mining claims, HRA, screenings with well-rounded programming
- Engage the right member, with the right message, at the right time
- Driving outcomes with incentives & lower plan cost, with a healthier population

The administration is built on a foundation of high-touch, customer service & account management, a turn-key full-service alternative health plan to the health insurance carriers. Our solutions bridge the gap by analyzing data, predicting future health costs, engaging the right members at the time in order to reduce spending- not the benefits.


- Self-insured and Self-insured with a safety net (level-funding)
- Health plans combined with Benefit, Wellness, and Incentive administration
- Driving member engagement incentives through medical and pharmacy benefits


Included with integrated enrollment and eligibility:
- Choice of network, plan, wellness, and incentive management
- ACA compliant
- Integrated enrollment and eligibility
- Drive performance of your plan and your people


Average Savings is $1,200.00 per employee per year!


Serviced Slush Puppie Corporation throughout all 50 states and 3 countries for over 30 years!



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PO Box 531778 CINCINNATI, OH 45253            513.661.7581            This email address is being protected from spambots. You need JavaScript enabled to view it.


We are Greater Cincinnati's Health Care Expense Reduction Experts; delivering the "Best of the Best," solving employer's benefit affordability issues.

We deliver concierge service, solving healthcare and healthcare benefit needs. Our custom crafted healthcare solutions create long-term solutions. Our benefits attract and retain talent. We improve benefit satisfaction and reduce healthcare need through better health. Technology, service and innovative risk management solutions that meet the serious challenges faced in the Era of Health Care Reform.

Our mission is to assist people in achieving a better state of health. A quality lifestyle is correlated with heatlhy behavior. We design benefits plans that are customer-focused solutions, identifyin benefits need from your past 24 months of healthcare consumption. We are recognized as an independent strategic partner.

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