3. Healthcare Benefit Financing

Aims and objectives of this chapter:

• Explain the challenges of healthcare financing

• Discuss various financing approaches of healthcare plans

• Explain the relationship between the Employee Retirement Income Security Act (ERISA) and self-funded plans

• Provide a comprehensive example of a self-funded plan

• Explain the concept of utilization review

• Introduce value-based benefit design

• Concluding thoughts on healthcare plan financing

The allocation of funds, general or specific, and the mechanisms used for paying these funds, makes up the umbrella topic of healthcare finance. Previously in this book, it has been mentioned that the overall design of employee healthcare benefits in recent years has been primarily, ...

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