The Truth About Self-funded Health Plans: Debunking 5 Common Misconceptions

There are a number of misconceptions about self-funded health plans. Let’s set the record straight. Here are five truths you should know about self-funded plans:

Medical plan costs are projected to rise an average of 5.6% per employee in 2023. This is a sharp increase from the 4.4% projected for 2022. Many employers are already experiencing strain as their health insurance premium costs skyrocket. As a result, more and more plan sponsors are seeing the financial advantages of switching to self-funding for employee healthcare benefits. But some are still hesitant to make the switch due to common misconceptions.

As a TPA with 30 years of experience specializing in self-funded benefits plans, we’re here to clear up the most common misunderstandings about self-funded plans, (also known as self-insured plans), so you can have the facts when deciding whether or not to make the switch.

Preconception #1: Self-funded plans aren’t cost-effective.

Not true. Not only are self-funded plans affordable — they save plan sponsors money.

Many employers are under the impression that with self-funded coverage, they must produce large sums of money on the spot to cover their employees’ claims whenever they arise. In actuality, plan sponsors pay a set sum each month so that they already have money saved for when it comes time to pay a claim. This sum takes workforce size and employee needs into account, making it a flexible monthly rate that is affordable and realistic in terms of projected medical costs. Self-funded plans reduce a plan sponsor’s overall costs, immediately saving them 2 to 3% on the cost of their plan, with the potential to save more, a lot more.

Furthermore, with a self-funded plan, companies only pay for medical costs their employees incur. So, if a business’ healthcare bills come in under their premium payments, that’s money returned at the end of the plan year.

This is a huge difference between self-funded and fully-funded (also known as fully-insured) insurance plans. With a fully-funded plan, even if a company’s healthcare costs come in under budget, their insurance company keeps the entire premium — a fact that you are probably already painfully aware of. But with self-funded coverage, companies have the potential to get money back at the end of the year, helping them score major savings.

Preconception #2: Self-funded insurance plans are labor-intensive.

False. A quality TPA takes care of all administration for you.

Plan sponsors often think that when self-funding employees’ coverage, they’ll be tasked with more administrative duties. This is simply not true when you work with a quality Third Party Administrator (TPA). A TPA creates a company’s plan and then handles all administrative aspects, including enrollment, compliance, and ongoing correspondence with employees when they have questions about their benefits. Because of the wide scope of what they cover, partnering with a TPA dramatically cuts in-house administrative workload and costs.

Preconception #3: Self-funded health plans only make sense for large companies.

Nope. Medium-size businesses can reap the rewards of self-funded coverage, too.

All the aforementioned money and time-saving benefits of self-funded coverage apply to mid-sized companies at comparable risk levels since plans are tailored to a company’s workforce. With a custom plan, cost is predictable. Plus, mid-sized companies can instantly cut the operational costs of a self-funded plan by working with a TPA.

Preconception #4: Self-funded insurance plans are limited in the scope of their offerings and provide little flexibility.

Wrong. With an experienced TPA as your partner, self-funded plans can be flexible and fully customized.

If you’re under the impression that self-funded plans have limited offerings — which could lead to poor employee satisfaction and problems with retention – you’ve been misled. In actuality, a TPA will take a look at a business’ needs and map out a custom plan that’s both targeted to the plan sponsor’s employee base and cost-effective. For instance, if a company has many employees with young children, the plan can prioritize family care. Similarly, self-funded plans can affordably cover behavioral health needs and complex or chronic conditions. And self-insured plans can stay flexible as a plan sponsor’s workforce evolves.

MagnaCare’s innovative offerings, such as ancillary benefits coverage and a case management program for individuals with more complex healthcare needs, are built to ensure plan sponsor’s employees get the care they need at minimal cost to you.

Preconception #5: Self-funded insurance plans are simply too much of a risk.

Incorrect. The financial risk of a self-insured plan is comparable to the risk of fully-insured coverage. Plus, there are self-insured safeguards to mitigate risk.

By its nature, all insurance reflects risk. Yes, there is a marginal risk in self-funding employee health coverage: there is a chance that at the end of the year, a client may end up owing more money than they planned due to unexpected medical events. However, consider the opportunity risk of a fully-insured insurance policy: even though the plan sponsor knows their set cost for the year upfront, they lose out on money if their medical costs come in well below the cost of their premium.

There are also self-funded features to mitigate cost-exposure risk if an employee (or one of their family members) has a catastrophic medical event or diagnosis. A self-funded plan with a stop-loss policy protects a plan sponsor for being on the hook for unexpectedly and extraordinarily large medical bills.


Now that you know the truth about self-funded plans

As a full-service, nationwide TPA with 30+ years’ experience, MagnaCare is the expert in high-quality, low-cost, innovative self-funded solutions. We work with plan sponsors to create custom self-insured health plans tailored to their budget and the unique needs of their workforce. Then, we handle all the administration — from enrollment to eligibility to EOBs. MagnaCare even helps navigate employees to lower-cost, higher-quality providers, so they can get the quality care they need at a lower claim rate. Plus, our award-winning intuitive platform and mobile app keep plan sponsors and their employees fully in the loop. Contact us to learn more facts and how we can assist you.






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Media Contact:
Erin George
[email protected]

MagnaCare and International Association of Fire Fighters Health & Wellness Trust Grow Benefits Administration Partnership

Expanded relationship extends national support for first responders

NEW YORK (Aug. 25, 2022)MagnaCare and the International Association of Fire Fighters Health & Wellness Trust have expanded their relationship to make high-value healthcare benefits available to first responders and their families nationwide. MagnaCare, a third-party administrator with deep expertise supporting Taft-Hartley trusts, serves as the TPA for all IAFF Health & Wellness Trust health plans, delivering administrative services and technology tools to support the trust’s rapidly growing member base.

Formerly known as Northwest Fire Fighters Benefits Trust, IAFF Health & Wellness Trust offers a slate of health benefit options specifically designed to meet the needs of firehouse employees and their families. Based in Washington state, the Trust currently serves more than 4,000 members in eight states. The Trust is expected to double in size in the next six months.

“We launched the Trust in 2013 to bring firefighters and their families comprehensive, affordable and sustainable health plans. We have experienced tremendous growth since then, and our recent rebranding and alignment with IAFF have further accelerated interest in the tailored health solutions we provide,” said Greg Markley, chairman of IAFF Health & Wellness Trust. “MagnaCare’s extensive knowledge and respect for labor groups, their willingness to integrate with our existing partners, and their proactive approach to bringing us innovative solutions make them the right partner for this next phase of growth.”

For more than 30 years, MagnaCare has been a trusted provider of third-party administration services to labor and other self-insured groups. Through its partnership with IAFF Health & Wellness Trust, MagnaCare provides benefit administration for all trust health plans, many of which use the Regence BlueCross BlueShield provider network. MagnaCare also delivers customer service, medical management, case management and telehealth support. The trust also leverages MagnaCare’s proprietary Create® Technology platform, which enables all aspects of health plan access, including tools for online open enrollment, benefits administration, and member activation and engagement.

IAFF Health & Wellness Trust and MagnaCare first partnered in 2018 for the state of Connecticut and extended the relationship in 2021 to five additional states.

“Our expanding relationship with IAFF Health & Wellness Trust is a testament to our mutual success to date and our shared commitment to making healthcare benefits access easier for first responders and their families,” said Michelle Zettergren, president of MagnaCare. “We look forward to collaborating to improve member experience while supporting the Trust’s rapid growth.”


About MagnaCare

For over three decades, MagnaCare, a national Third Party Administrator has been building healthy communities together with Taft-Hartley trusts, providers, other TPAs, carriers, and workers’ compensation and no-fault payors. Its wholly owned networks, full health plan management services, extensive trust and welfare administration services, comprehensive in-house medical management services, and leading outcomes-based casualty solutions offer the ultimate flexibility and customization that help clients simplify administration, control healthcare costs, improve health, and achieve exceptional value. MagnaCare is a division of Brighton Health Plan Solutions, LLC. Learn more at

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Media Contact:
Erin George
[email protected]

Infographic: Expand Your Network Reach

Offer your clients access to leading local and national provider networks, and lower their healthcare costs.

TPAs and carriers trust MagnaCare for high-quality, affordable network access. Rely on our expertise to:

  • Gain access to top-quality providers, with deep discounts and lower total cost of care
  • Customize your network with the locations and providers you want to access
  • Contract with providers and health systems to build unique networks for your clients
  • Provide cost-saving services that lower your clients’ healthcare costs, such as medical management and redirection of care services

View the infographic and contact us for more details about our network access offering.

Access Network infographic

MagnaCare Spotlights Labor Union Voices with LaborStrong.Live

New online video community shares the stories and issues that matter to American workers


NEW YORK (April 14, 2021) – MagnaCare, a third-party administrator with a long history of serving the healthcare benefits needs of organized labor groups, today announced the launch of a new online video community for labor. The site, LaborStrong.Live, gives union leaders, labor members and supporters, including celebrity guests impacted by labor, a stage to voice their perspectives on timely labor topics. MagnaCare developed the site as a destination for those in labor professions and the general public to appreciate the incredible history of labor, celebrate its future, and learn about the people, subjects and stories that matter to American workers.

“As a longtime partner to organized labor, we deeply care about the issues that face this vibrant community and their many victories defending the rights of workers. Labor has so many powerful stories and important lessons that need to be heard,” said Michelle Zettergren, President of Labor at MagnaCare. “We created LaborStrong.Live as an open community for labor leaders, workers, and supporters to gather and share their insights, experiences, and views with one another and with anyone in the general public who wants to better understand the forces behind the current labor movement in the U.S.”

LaborStrong.Live launches with a library of more than a dozen inspirational videos discussing matters ranging from safety measures used to protect frontline workers during the coronavirus pandemic to labor considerations in the push toward cannabis legalization. Among the many individuals featured are Gary LaBarbera, President of the Building and Construction Trades Council of Greater New York; Vincent Alvarez, President of the AFL-CIO New York City Central Labor Council; and Joseph Azzopardi, Business Manager and Secretary Treasurer of IUPAT District Council 9. Actor and SAG-AFTRA member Ernie Hudson appears in several videos answering questions about being a union member, some of his most famous movie roles, and more.

MagnaCare plans to upload additional videos in the weeks ahead and encourages more unions and supporters to contribute their stories. Visit LaborStrong.Live for the latest content.

About MagnaCare

For nearly three decades, New York-based MagnaCare has been building healthy communities together with Taft-Hartley trusts, TPAs, carriers, and workers’ compensation and no-fault payors. Its wholly owned networks, full health plan management services, trust and welfare administration services, comprehensive in-house medical management, and leading outcomes-based casualty solutions offer the ultimate flexibility and customization that help self-insured customers control healthcare costs, improve health, and achieve exceptional value. MagnaCare is a division of Brighton Health Plan Solutions, LLC. Learn more at

Media Contact:

Erin George
[email protected]

5 Important Healthcare Lessons from COVID-19

COVID-19 is an unprecedented occurrence that has impacted employer-sponsored healthcare. The best a company can do to be prepared going forward is to learn from every situation. When considering your employee healthcare benefits, there are some important takeaways from COVID-19.

1. Promote preventive care

Healthier people who contracted COVID-19 fared better than people who were immunocompromised. Routine preventive care leads to early detection and even prevention of serious conditions – which not only assures a healthier workforce and better health outcomes, but also avoids costly medical treatments.

2. Tout telehealth

Telehealth – virtual doctor visits via video, phone, or chat – increased by 80% in 2020 due to the COVID-19 pandemic. Continuing to offer a telehealth benefit can lower your healthcare costs by reducing the number of visits to costlier urgent care centers and emergency rooms. Employers can also find long-term savings from telehealth support for preventive care, treatment for chronic conditions, and mental health services.

3. Embrace technology

It’s become clear that anywhere, anytime access to your payroll, accounting, benefits, and eligibility information is a must-have in keeping your employees covered. When these functions work online and in concert, there is no disruption in giving your employees the benefits they deserve. Employees also need a way to access their benefits remotely and remove the burden from your Benefits team.

4. Contain your costs

Lessons from the past – not just from COVID-19 – show that businesses should be prepared for an economic downturn. There are creative ways you can lower your healthcare costs while providing your employees with the same high level of healthcare benefits – such as utilization review, case management programs, site-of-service relocation, and tiered benefit plans that direct your employees to high-value providers. An advantage of self-insured health plans is that you can plan changes mid-year, enabling you to react swiftly to any changes in your situation.

MagnaCare offers a wide range of healthcare benefits products and services that can lower your costs while providing high-quality care. And its award-winning healthcare technology platform streamlines your work while enabling remote access for your admins and employees.

5. Explore alternatives

There are alternatives to PPO plans, such as Consumer-Driven Health Plans (CDHP), which are high deductible plans, and Minimum Essential Coverage (MEC) plans. MEC plans fulfill your ACA requirement by giving employees basic coverage. We offer Enhanced MEC plans that include the services your employees want and need.

During the pandemic, some of our clients looked to MEC to cover furloughed workers. You may also want to consider different levels of health benefits for different employee roles, such as MEC plans for certain levels of your workforce such as interns and apprentices, and PPO plans for more permanent roles.

Contact us to discuss how our innovative healthcare enablement solutions can benefit your business.

MyMEC Minimum Essential Coverage by MagnaCare

MEC brochureMagnaCare offers a range of customizable MyMEC Minimum Essential Coverage plans, to meet your clients’ preferred level of coverage. Your clients can optionally add vision, pharmacy, and other benefits to any MyMEC plan.

Download the brochure for more details about our MyMEC health plans.

MyMEC plans eliminate the costly penalty that employers would otherwise have to pay for each employee under the Affordable Care Act (ACA) by covering preventive and wellness-related tests and treatments.

Since MyMEC plans are self-funded, they are exempt from state coverage mandates and state taxes.

MagnaCare’s Health Utilization Management Program Once Again Achieves URAC Accreditation

URAC accreditationNEW YORK, NY (Feb. 9, 2020) – New York-based healthcare enablement company Brighton Health Plan Solutions, parent company to MagnaCare, has earned national accreditation in Health Utilization Management from URAC, an independent leader in promoting healthcare quality through leadership, accreditation, measurement and innovation. The in-house Health Utilization Management program used by Brighton and MagnaCare clients has continuously held this accreditation since its inception. Its current accreditation is valid until March 2024.

Brighton helps self-insured clients, their members and their healthcare providers realize more value in employer-sponsored benefits by offering unprecedented flexibility and customization in its third-party administration of workplace benefits, innovative provider networkscasualty solutions, and integrated technology platform.

“Brighton Health Plan Solutions is dedicated to working with benefit plan sponsors to improve value in healthcare,” said A. Bartley Bryt, MD, MPH, the company’s Chief Medical Officer. “Our URAC reaccreditation for the fourth straight evaluation period underscores our commitment to excellence and quality through compliance with the industry’s most rigorous standards.”

URAC accreditation means Brighton demonstrated an ability to improve the quality and effectiveness of patient care while eliminating unnecessary treatment and expense. Organizations that achieve URAC’s Health Utilization Management distinction adhere to evidence-based quality improvement guidelines that enhance care delivery, protect patient safety, and optimize operational efficiencies. Accredited organizations exhibit competency in utilization management and consistent and unbiased medical necessity and benefit coverage determinations.

URAC accreditation is recognized by employers, unions, and federal and state government benefit programs.

About MagnaCare

For nearly three decades, New York-based MagnaCare has been building healthy communities together with Taft-Hartley trusts, TPAs, carriers, and workers’ compensation and no-fault payors. Its wholly owned networks, full health plan management services, trust and welfare administration services, comprehensive in-house medical management, and leading outcomes-based casualty solutions offer the ultimate flexibility and customization that help self-insured customers control healthcare costs, improve health, and achieve exceptional value. MagnaCare is a division of Brighton Health Plan Solutions, LLC. Learn more at

About URAC

Founded in 1990 as a nonprofit organization, URAC is the independent leader in promoting healthcare quality and patient safety through renowned accreditation programs. We develop our evidence-based standards in collaboration with a wide array of stakeholders and industry experts. Our portfolio of accreditation and certification programs span the healthcare industry, addressing management and operations, pharmacies, telehealth, health plans, medical practices and more. URAC accreditation is a symbol of excellence for organizations to showcase their validated commitment to quality and accountability.

Media Contact:

Erin George
[email protected]

MagnaCare and Mount Sinai Health System Launch Center of Excellence

Mount SinaiNEW YORK (Dec. 15, 2020)

MagnaCare, an administrative services organization helping self-insured employers achieve greater healthcare value, has partnered with the Mount Sinai Health System to develop a Centers of Excellence program for total joint replacement surgery. The program is designed to enhance patient care and experience, while also reducing costs for health plan sponsors and their members.

Through the partnership, MagnaCare will guide its clients’ eligible members to preferred Mount Sinai facilities and providers for total joint replacement procedures. Top Mount Sinai clinicians will perform the surgery and all associated services — from pre-surgical office visits to follow-up care and physical therapy — under a single, bundled payment. In addition, each member will be connected to a Mount Sinai Care Guide who will provide personalized support to help members navigate their care journey, including providing information about their procedure, coordinating any pre-surgery testing requirements, and securing free transportation and other post-surgery needs.

“Our customers rely on MagnaCare to develop innovative solutions that deliver better service, improved health outcomes, and enhanced value for their members,” said Michelle Zettergren, President of Labor at MagnaCare. “By partnering with Mount Sinai to develop a Center of Excellence for total joint replacement surgery, we can promote positive patient outcomes while removing much of the burden and financial uncertainty that so often come with complex care. Members will have peace of mind knowing that they’re in good hands and won’t have to deal with unpredictable or out-of-network costs.”

Mount Sinai is an integrated health care system encompassing the Icahn School of Medicine at Mount Sinai, eight hospital campuses in the New York metropolitan area and a large, regional ambulatory footprint. The health system has been awarded Advanced Certification in Total Hip and Knee Replacement surgery from the Joint Commission.

“We are convinced Centers of Excellence are a better way to provide complex, scheduled surgical services, and we’re proud to partner with MagnaCare to launch this new program,” said Lucas Pauls, Labor Lead for Mount Sinai Health Partners. “By working together, we can ensure access to high-quality care for joint replacement while eliminating surprise bills and confusion about benefits or out-of-pocket costs.”

About MagnaCare

For nearly three decades, New York-based MagnaCare has been building healthy communities together with Taft-Hartley trusts, TPAs, carriers, and workers’ compensation and no-fault payors. Its wholly owned networks, full health plan management services, trust and welfare administration services, comprehensive in-house medical management, and leading outcomes-based casualty solutions offer the ultimate flexibility and customization that help self-insured customers control healthcare costs, improve health, and achieve exceptional value. MagnaCare is a division of Brighton Health Plan Solutions, LLC. Learn more at

About Mount Sinai

The Mount Sinai Health System is dedicated to serving New York City’s labor market, and has created a dedicated team to do just that. Mount Sinai’s Commercialization team has assembled the system’s clinical and population health assets into product offerings tailored to meet labor unions’ needs. Mount Sinai’s initial product portfolio includes specialty care bundles and worksite health centers (on-site and near-site) plans – all which are supported by a navigation team.

Mount Sinai is the largest academic medical system in New York City, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai is a national and international source of unrivaled education, translational research and discovery, and collaborative clinical leadership ensuring that we deliver the highest quality care—from prevention to treatment of the most serious and complex human diseases. Mount Sinai includes more than 7,200 physicians and features a robust and continually expanding network of multispecialty services, including more than 400 ambulatory practice locations throughout the five boroughs of New York City, Westchester, and Long Island. Learn more at

Media Contact:

Erin George, Lovell, 615-946-9914, [email protected]



Seattle-based SEIU 775 Benefits Group chooses MagnaCare’s new and expanded technology-powered Trust and Welfare Administration Services

NY-based TPA continues its nationwide growth with launch of additional services

SEIU 775 Benefits GroupNEW YORK (November 11, 2020) – MagnaCare, a third party administrator with deep expertise supporting Taft-Hartley trusts, today announced Seattle-based SEIU 775 Benefits Group has chosen MagnaCare’s new and expanded Trust and Welfare Administration Services to enable contribution accounting, financial administration, employee hours administration, enrollment and eligibility determination, and COBRA administration. SEIU 775 Benefits Group will partner with MagnaCare to support its Health Benefits Trust, offering high-value, high-impact health benefits to more than 53,000 caregivers in Washington State and Montana.

For 30 years, MagnaCare has been a trusted provider of third party administration services to self-insured groups. A nationally recognized leader in health benefit solutions, MagnaCare conducts business in all 50 states. In this new relationship, MagnaCare will provide technology-powered Trust and Welfare Administration Services to SEIU 775 Benefits Group.

“MagnaCare has always had strong reputation as a reliable and responsive partner for self-insured health plan administrators. Over the past several years, we have been heavily investing in our innovative healthcare technology platform to power the additional services that our clients expect from us,” said Michelle Zettergren, President, Labor. “We are proud to launch our new and expanded Trust and Welfare Administration Services nationally, designed in partnership with SEIU 775 Benefits Group. MagnaCare looks forward to continue to grow and innovate to serve even more Taft-Hartley trusts across the country.”

“We were looking for an innovator in benefits administration, with creative solutions, who will partner with us to help our Health Benefits Trust better serve our caregivers,” said Laura Reding, Managing Director of SEIU 775 Benefits Group Health Benefits Trust. “MagnaCare’s deep knowledge of healthcare combined with its agile technology platform makes them the perfect partner to help us administer the Health Benefits Trust and support the health of frontline, essential caregivers.”

About MagnaCare

For nearly three decades, New York-based MagnaCare has been building healthy communities together with Taft-Hartley trusts, TPAs, carriers, and workers’ compensation and no-fault payors. Its wholly owned networks, full health plan management services, trust and welfare administration services, comprehensive in-house medical management, and leading outcomes-based casualty solutions offer the ultimate flexibility and customization that help self-insured customers control healthcare costs, improve health, and achieve exceptional value. MagnaCare is a division of Brighton Health Plan Solutions, LLC. Learn more at

Never had a flu shot before? Make this year your first.

It’s not too late to get the flu shot. In fact, never has it been more important.

Five Reasons Why You Should Get Your Flu Shot:

1. You never forget the flu.

It can be miserable. It can also be deadly. People with flu can experience symptoms such as high fever, severe muscle ache, lack of energy, chills, cough, and congestion. Complications of flu can include bacterial pneumonia, ear infections, sinus infections, and worsening of chronic medical conditions. In the 2019-2020 flu season, 39-56 million people got the flu and 29,000-62,000 died.

2. It’s an effective vaccine.

The vaccine reduces your chance of infection. If you do still catch the flu, the flu shot will likely lower your risk of complications, severe illness, or death. While it’s good to get the flu shot early, you can get the flu vaccine anytime during the flu season, which typically lasts from October through March and sometimes as late as May. In order of cost-effectiveness, the best location to get the flu vaccine is at a local pharmacy such as Walgreens or CVS, followed by a retail clinic, and then the physician’s office.

3. You don’t want COVID-19 and the flu at the same time.

Both these viruses target your lungs, which means you can get sicker than if you had just one virus alone.

4. The flu spreads easily and anyone can get it, including healthy people.

Mostly the viruses influenza A and influenza B cause the flu. Both viruses have strains that mutate often, so every year new flu vaccines are released based on which flu strains are currently in circulation. This is why you need to get the flu shot every year.

5. It can keep you out of the hospital.

Because the flu season coincides with a pandemic, there may not be enough healthcare resources to support a large influx of both flu and COVID-19 patients simultaneously. In the 2019-2020 flu season, 410,000-740,000 flu patients were hospitalized.

The CDC recommends that children over 6 months old and adults should get the flu shot. Flu shots are available at most pharmacy chains, and they’re no cost with most insurance.

Premium holidays are no reason to celebrate

City & State logoA premium holiday is where health insurance companies forego premiums when claim volume is low, since by law, insurance companies are obligated to spend 80% of premiums on medical expenses. But even in normal years, health insurance companies’ projections are typically too high. A more cost-effective approach for companies is to self fund their health plans, where they pay according to utilization. Read more

Waterbury Health joins the trend

Waterbury HEALTH in Connecticut recently became part of an integrated delivery network set up by Brighton Health Plan Solutions, a New York-based company that brokers healthcare services between providers and employers.

In an integrated delivery network, or IDN, employees can receive their medical care exclusively from one health system. “IDNs have been around for some time,” said Robin Brand, senior director of research for The Advisory Board, a best practices research firm for the healthcare industry. “There’s been more interest in them in the past couple of years.”

One key feature of an IDN is that a patient’s care is better coordinated between providers that belong to the same network. From the patient’s perspective, it feels like a very different experience and the care is more integrated. And “if you have better coordination, you’re going to have fewer repeat tests or a lack of follow-up that could end up in higher costs down the line,” Brand said.

Read more (subscription required)

Antibody Testing Options

Antibody testing is a way to find out if you had COVID-19 and recovered. (Learn more about antibody testing.) If you’re interested in getting tested for COVID-19 antibodies, here are your best options:

Primary Care Doctor

Your doctor may offer to do the blood draw in the office. Please be sure to request that the sample be sent to a free-standing lab participating in your health plan, not to a hospital lab. There is no member cost share for the blood test or the accompanying provider visit.

Free-Standing Labs

You can visit an in-network, free-standing lab (such as a BioReference Laboratories, Labcorp, or a Quest Diagnostics patient service center) for the blood draw. A prescription is required. To obtain a prescription, contact your primary care doctor. If you do not have a primary care doctor, you can contact any primary care doctor in the MagnaCare or Create network (depending on your plan). There is no member cost share for the blood test or the accompanying provider visit.

Self-Pay Testing

Otherwise, you can choose to self-pay and schedule an antibody test directly through LabCorp or Quest Diagnostics or other self-pay providers. You are responsible for the full cost at the time of the test if you choose this option. These direct-to-consumer options are NOT covered under health plans, including the MagnaCare or Create health plans, and cost significantly more than the insurance rates. There are no FDA-authorized antibody home testing kits at the moment.

While urgent care centers and hospitals do also offer antibody testing, keep in mind that these providers cost the plan significantly more to cover. You may also have more exposure to people sick with COVID-19 at urgent care centers or hospitals. For these reasons, we encourage you to instead call a primary care doctor for the prescription and visit a free-standing lab to safely get tested for COVID-19 antibodies.

Why more companies are switching to self-funded health plans

As healthcare costs continue to spiral out of control, employers are increasingly looking to self-fund their employee healthcare benefits.

With fully insured health plans, you pay a monthly premium to a health insurance company. Once the insurance company wins your business, it’s not unusual to be hit with a double-digit premium rate increase the following year. That explains why employers shop around for a new health insurer every three years, on average.

Self-funded health plans are not health insurance. You don’t pay premiums to an insurance company, and you don’t submit your claims to them. Rather, you set aside a certain amount for funding your employees’ healthcare claims. And you purchase stop-loss insurance to cover unanticipated high claims costs. Typically you would use a third party administrator (TPA) to manage your claims and advise you on your health plan.

5 advantages of self-funding over fully insured health plans:

1. Full transparency

Self-funded groups can access IT tools and services that makes it easy to analyze claims data. Having a direct window into the claims you are funding guides you to timely and targeted decisions that can improve your members’ health and well-being and control costs.

2. Cost savings

Self-funded benefit plans reduce your premium tax, immediately saving you 2-3% on the cost of the plan. Self-funded plans are subject only to the federal Employee Retirement and Income Security Act (ERISA) so there are no state mandate costs. Your TPA will negotiate fees with providers, and will arrive at reasonable reimbursements for services that offer significant savings over an employer’s typical fully insured plan. TPAs will also audit bills and implement other cost-saving programs. For example, MagnaCare’s innovative Redirection of Care programs find more convenient, lower cost, high-quality sites of service for your health plan member to receive the care they need.

3. Flexibility over covered services

Fully insured groups are subject to the insurer’s discretion and their specific population’s needs may not be met. In contrast, self-insured employers have the authority at any time to make informed changes to their covered services to ensure their population receives the care they need. This capability has proved especially helpful in times of change or economic downturn.

4. Better control over finances

With a fully insured plan, you pay the full premium regardless of actual claims. If claims don’t materialize, you don’t receive a refund. But with self-funded plans, you pay only for services received by your employees. And when eligible medical claims for a plan year do not exceed a predetermined limit, the plan keeps those dollars and they can be used to offset the following year’s expenses or reduce contribution levels.

5. Easier administration and lower operational costs

Your TPA approves or renegotiates claims, decides appeals, and handles other time-consuming administrative tasks. Overall administrative costs for a self-funded program handled by a professional TPA such as MagnaCare are usually lower than costs charged by the insurance carrier.

Contact us to see how much your company can save by self-funding your healthcare benefits. We’ll design a plan tailored to your employees’ needs. Our team of healthcare actuaries will work with you to help you determine the level of coverage you require, based on your historical claims data.

A Path to a Return to Normal

As we continue to adjust to the COVID-19 pandemic, I am regularly impressed by displays of our clients’ dedication to their members’ health and safety. Return-to-work, or continue-to-work, can pose challenges. But with the right precautions in place, organizations can build their path to normal.

The CDC offers a number of recommendations for workplaces to prevent and reduce transmission among workers, including:

  • Educate employees about how to protect themselves at home, at work, and when commuting
    to work, and inform them of any new workplace policies or procedures.
  • Actively encourage sick employees to stay home and notify their supervisor if sick or have been
    exposed to someone who is sick.
  • Consider conducting private, daily, in-person or virtual health checks for symptoms or a
    temperature screening before employees enter a facility. Conduct them safely, respectfully,
    and in accordance with social distance guidelines, local and State public health guidelines, and
    guidance from the Equal Employment Opportunity Commission.
  • Identify where and how workers might be exposed to COVID-19 at work and limit the spread
    of the virus by looking at an appropriate combination of engineering controls, regular cleaning
    and disinfection, workplace administrative policies, face coverings, and personal protective equipment.
  • Separate sick employees who appear to have symptoms when they arrive to work or become sick during the day from others and send them home or to a healthcare provider safely.
  • Take action to disinfect and close of any areas used by an employee suspected or confirmed to have COVID-19 and inform impacted employees about their possible exposure, but maintain employee confidentiality.

Check the CDC for more information on their recommendations. You can also refer to OSHA which has prepared detailed guidance for employers with steps to take according to the exposure risk.

As another sign of the region reopening, we are now seeing hospital claim volume picking back up as hospitals resume normal operations and reinstate elective surgeries in regions cleared to do so by the Department of Health. In the New York metro area, Westchester, Rockland, Suffolk, and Nassau County hospitals, in addition to many counties in upstate New York, have restarted elective procedures and ambulatory care this month, after these counties met the State’s criteria. New Jersey hospitals will be allowed to resume elective surgeries and invasive procedures on May 26. In all cases, procedures will resume according to policies issued by each individual State.

MagnaCare and BioReference Laboratories Bring COVID-19 Antibody Testing to New York Labor Groups

Collaboration supports return-to-work planning for key workforce groups

NEW YORK, May 18, 2020 – MagnaCare, today announced a collaboration with BioReference Laboratories, Inc., an OPKO Health company (NASDAQ: OPK), to bring COVID-19 antibody testing to their Labor clients in the New York metropolitan area. Through this collaboration with BioReference Laboratories, MagnaCare will offer on-site antibody blood testing to Labor members, delivering valuable information as the city, employers and individuals plan return-to-work strategies.

“As New York’s coronavirus outbreak has continued to unfold, our Labor partners have been eager for information and guidance on COVID-19 antibody testing — particularly since skilled trade groups will be among the first to return-to-work and begin re-energizing the local economy,” said MagnaCare President Michelle Zettergren. “Antibody testing can support decision-making about back-to-work procedures and safety measures for protecting workers and the public. We’re proud to bring this service to our clients so they have more knowledge, and hopefully some peace of mind, in this challenging environment.”

BioReference Laboratories, which recently worked with New York State and New York City to provide COVID-19 antibody testing, offers a blood test that measures SARS-CoV-2 specific antibody levels to help determine an individual’s immune response after COVID-19 infection. Although the presence of antibodies are typically associated with immunity, the scientific community is still working to understand what level of antibodies might be needed for protection from reinfection with COVID-19, and how long that protection might last.

The collaboration will begin with on-site testing for the District Council 9 of the International Union of Painters and Allied Trades (IUPAT) on May 18-20. The on-site testing is available to DC 9 members, who must go online to pre-register and schedule their test. The cost will be fully covered by the union, and results will be emailed directly to members within 72 hours.

“Our goal is to get our members back to work with comfort and confidence,” said Joseph Azzopardi, Business Manager and Secretary Treasurer of DC 9. “We’re grateful to MagnaCare for providing a convenient testing option so we can all decide how best to move forward in the days and weeks ahead.”

MagnaCare is also working with some of its other New York-based Labor partners to establish additional on-site testing locations this month.

About MagnaCare

For 30 years, MagnaCare has been building healthy communities together with Taft-Hartley Funds, TPAs, carriers, and workers’ compensation and no-fault payors in the New YorkNew Jersey, and Connecticut tri-state area. Its broad and wholly owned network, full health plan management services, comprehensive in-house medical management, and leading outcomes-based casualty solutions offer the ultimate flexibility and customization that help customers control healthcare costs, improve health, and achieve exceptional value. MagnaCare is a division of Brighton Health Plan Solutions, LLC.

About BioReference Laboratories, Inc.

BioReference provides comprehensive testing to physicians, clinics, hospitals, employers, government units, correctional institutions and medical groups.  The company is in network with the five largest health plans in the United States, operates a network of 10 laboratory locations, and is backed by a medical staff of more than 160 MD, PhD and other professional level clinicians and scientists.  With a leading position in the areas of genetics, women’s health, maternal fetal medicine, oncology and urology, BioReference and its specialty laboratories, GenPath and GeneDx, are advancing the course of modern medicine.  For more information, visit

Media Contact for MagnaCare:

Erin George
[email protected] 

Media Contact for BioReference Laboratories:

Hillary Titus
[email protected]