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FAQs

Q: If my self-funded plan isn't working, does that mean self-funding was the wrong choice?

Not usually. Most "failing" plans have one or two broken vendors in the stack, not a broken model. Replacing the weak link is almost always cheaper and less disruptive than moving back to fully insured.

Q: What's most often the actual problem when a self-funded plan underperforms?

A handful of usual suspects: a PBM with spread pricing that's never been audited, a TPA that's slow or unresponsive, a specialty pharmacy carve-out that was never implemented correctly, or stop-loss terms that don't line up with the current plan design.

Q: How do I know which vendor in my stack is the problem?

Start by asking when your PBM contract was last audited, how quickly claims get processed, whether your specialty carve-out actually works the way it was sold, and whether your stop-loss terms still match your plan. Vague or missing answers usually point to where the gap is.

If my self-funded plan isn’t working, does that mean self-funding was the wrong choice?

Not usually. Most "failing" plans have one or two broken [...]

By Ohio Health Benefits Team|2026-09-14T14:04:40-04:00September 14th, 2026|Most "Failed" Self-Funded Plans Aren't Actually Failing|0 Comments

What’s most often the actual problem when a self-funded plan underperforms?

A handful of usual suspects: a PBM with spread pricing [...]

By Ohio Health Benefits Team|2026-09-14T14:03:32-04:00September 14th, 2026|Most "Failed" Self-Funded Plans Aren't Actually Failing|0 Comments

How do I know which vendor in my stack is the problem?

Start by asking when your PBM contract was last audited, [...]

By Ohio Health Benefits Team|2026-09-14T14:01:49-04:00September 14th, 2026|Most "Failed" Self-Funded Plans Aren't Actually Failing|0 Comments

Do I have to switch every vendor if my plan isn’t performing?

No. Self-funding is built as separate pieces on purpose, which [...]

By Ohio Health Benefits Team|2026-09-14T13:59:59-04:00September 14th, 2026|Most "Failed" Self-Funded Plans Aren't Actually Failing|0 Comments

What’s the difference between self-funded and level-funded health plans?

With a self-funded plan, your business pays employee claims directly, [...]

By Ohio Health Benefits Team|2026-08-26T15:01:17-04:00August 26th, 2026|self-funded and level-funded health plans|0 Comments

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CUSTOMER SERVICE

For questions regarding sales or service, please call us at
Phone: 330.633.7713
Email: healthsales@ohiohealthbenefits.net

CORPORATE OFFICE

125 West Avenue, Suite 101 • Tallmadge, OH 44278
Phone: 330.633.7713
Fax: (330) 633-7726
Email: healthsales@ohiohealthbenefits.net

CANTON OFFICE

7567 Freedom Ave NW • North Canton, OH 44720
Phone: 330.952.9044
Fax: (330) 633-7726
Email: healthsales@ohiohealthbenefits.net

HIRAM OFFICE

11681 Hayden Street • PO Box 411 • Hiram, OH 44234
Phone: 330.569.3379
Fax: (330) 633-7726
Email: healthsales@ohiohealthbenefits.net

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

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