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Medical ExpenseSeen in 3 questions

ERISA

The federal employee retirement income security law that preempts state regulation of self-funded employee benefit plans, setting fiduciary and disclosure standards instead.

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Practice This Concept

Which statement correctly distinguishes a fully insured group health plan from a self-insured (self-funded) plan?

In a fully insured plan the insurer assumes the risk of claims, while in a self-insured plan the employer assumes that risk and may purchase stop-loss coverage — In a fully insured group plan, the employer pays premiums to a licensed insurer, and the insurer assumes the risk of paying claims. In a self-insured (self-funded) plan, the employer assumes the claims risk directly and commonly buys stop-loss insurance to cap catastrophic exposure, often hiring a third-party administrator to run the plan. Because the employer bears the risk, self-funded plans are generally governed by ERISA rather than by state insurance regulation. This risk-bearing difference is the central distinction between the two funding arrangements.

National insurance concept

An employer wants to provide supplemental retirement income to a valued executive using life insurance. The company owns and pays for the policy, and the death benefit is payable to the company. This arrangement is best described as:

Deferred compensation funded with life insurance — In a deferred compensation plan, the employer promises to pay the executive benefits later, typically at retirement, and life insurance may be used to fund that obligation. The employer owns the policy, pays the premiums, and is the beneficiary; the policy's cash value builds tax-deferred to fund the future benefit. This differs from key person insurance, which protects the company against the death of a vital employee, and from salary continuation, which provides continuing pay to surviving dependents. Under split dollar, the employer and the employee or a third party share the policy's premiums and benefits.

National insurance concept

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