Funding and Finance of Health Benefits
Topics Covered
- Pillars of financing
- Risk management
- Financing mechanisms
- Funding vehicles
- Employee contributions
- External landscape
- Self-funding
- Scenarios in transitioning from one financing type to another
- Case study
Course Outline
Day 1
- Introductions
- Pillars of Financing
- Fully insured vs. Self-funded
- Fully insured rating alternatives
- Self-funded administration alternatives
- Funded vs. unfunded plans
- Factors to consider for self-insuring
- Claims predictability
- Organization's/fund's finances
- Administration
- Taxes
- Plan design
- Employee population characteristics, related health care costs and cost containment initiatives
- Employee communications and relations
- Risk Management
- Risk Management Spectrum
- Frequency and severity
- Financing Mechanisms
- Concepts in this section include:
- Creditability of a group
- Surplus, deficit and retention
- Reserves
- Pooling
- Advantages, disadvantages and prevalence statistics of financing options
- Future trends outlook
- Fully Insured
- Experience Rated
- Premium Delay
- Minimum Premium
- Self-Funded
- The concept of stop-loss insurance
- Administrative Services Only vs. Third-Party Administration
- ERISA preemption
- Funding Vehicles
- General Assets
- Trust
- VEBA
- Captive Insurance Company
- Employee Contributions
- Methodologies
- Credit and surcharge strategies
- External Landscape
- Private exchanges
- Group captive arrangements
- Affordable Care Act (ACA) taxes and fees
- Actuarial Value (AV) calculator explanation and demonstration
Day 2
- Self—Insured (The deep dive)
- Health care insurance food chain
- Payers
- Components of a claim
- Stop-loss insurance
- Specific, aggregate, aggregating specific
- Types of stop loss contracts
- Pricing of stop loss coverage
- Purchase and renewal decision points
- Expected incidence and severity rates
- Incurred but not paid (IBNP) reserves—Assessing and developing
- Setting and underwriting premium equivalent (PE) and COBRA rates
- Claims data
- Census data
- Fees
- Vendor administration
- Prescription drug rebates
- Creditability of the group
- Plan design(s)
- Health care cost trend rate assumptions
- Claims Adjudication Components
- Transitioning Scenarios
- When do you consider transitioning?
- Who provides the transition alternatives and analysis?
- What steps need to be taken?
- Case Study
In the case study, class participants are broken up into groups based on whether they represent a multiemployer or a single employer plan sponsor. Each group reads about a fictitious scenario, draws conclusions, collaborates on recommendations, and then reports their findings and recommendations back to the entire classroom.
Course Applies To
April 29 - 30, 2026
Hilton Scottsdale Resort & Villas,
Scottsdale, AZ
Pricing
Through March 16, 2026
US$1,495.00
Member
US$1,715.00
Nonmember
After March 16, 2026
US$1,795.00
Member
US$2,015.00
Nonmember
September 28 - 29, 2026
Caribe Royale Orlando,
Orlando, FL
Pricing
Through August 17, 2026
US$1,495.00
Member
US$1,715.00
Nonmember
After August 17, 2026
US$1,795.00
Member
US$2,015.00
Nonmember
Continuing Education
Educational sessions at this program can qualify for CEBS Compliance credit. Visit www.cebs.org/compliance for more information.
Agenda
Wednesday, April 29 - Thursday, April 30, 2026
Hilton Scottsdale Resort & Villas, Scottsdale, AZ
8:00 AM - 5:00 PM
8:00 AM - 3:00 PM
Monday, September 28 - Tuesday, September 29, 2026
Caribe Royale Orlando, Orlando, FL
8:00 AM - 5:00 PM
-
Elizabeth Allen, CEBS
-
Steven Draper
8:00 AM - 3:00 PM
-
Elizabeth Allen, CEBS
-
Steven Draper