PPO. plan has an individual deductible of $3500, individual OOP max of $6500, family deductible of $6750, and family OOP max of $13000

(http://www.autoadmit.com/thread.php?thread_id=5788786&forum_id=2Reputation#49367066)

we did the math, knowing we were having a baby this year. it was still better do deal with this shitty $6500 OOP to have a baby than pay high premiums.

(http://www.autoadmit.com/thread.php?thread_id=5788786&forum_id=2Reputation#49367092)

i really wonder how much this shitty plan is costing them

(http://www.autoadmit.com/thread.php?thread_id=5788786&forum_id=2Reputation#49367215)

(http://www.autoadmit.com/thread.php?thread_id=5788786&forum_id=2Reputation#49367227)

do u need referrals to go to specialists, or can u just go to whatever specialist you cant?

(http://www.autoadmit.com/thread.php?thread_id=5788786&forum_id=2Reputation#49368707)

I think you just go but haven't actually used it that much. We mainly use it for our pediatrician. We just go and have never needed to pay anything.

(http://www.autoadmit.com/thread.php?thread_id=5788786&forum_id=2Reputation#49368716)

so the actual employers costs is: cost to pay administrator + cost for castrophic coverage + actual healthcare invoiced - premiums and copay you pay - tax savings

(http://www.autoadmit.com/thread.php?thread_id=5788786&forum_id=2Reputation#49367871)

The claim about large employers "self-insuring" instead of providing traditional insurance is largely true, but let’s break it down with clarity and avoid inflammatory language or assumptions.Many large employers in the U.S. do opt for self-insured (or self-funded) health plans rather than purchasing traditional group health insurance from an insurer. Here's how it works and whether the description holds up:Self-Insurance: In a self-insured plan, the employer assumes the financial risk for employees’ healthcare costs, paying claims directly out of their own funds instead of paying premiums to an insurance company for full coverage. This is common among large employers (e.g., Fortune 500 companies) because they have the financial resources and employee pool size to spread the risk.

Third-Party Administrators (TPAs): Employers typically hire a third-party administrator (often a company like Cigna, Aetna, or Blue Cross) to manage the plan, process claims, and handle administrative tasks. These TPAs are paid fees for their services, but they don’t bear the financial risk of claims—the employer does.

Stop-Loss (Catastrophic) Coverage: To protect against extremely high claims (e.g., a single employee incurring millions in medical costs), self-insured employers often purchase stop-loss insurance. This kicks in when claims exceed a certain threshold, either per employee (specific stop-loss) or for the entire plan (aggregate stop-loss).

Cost Structure: The description of costs is accurate: an employer’s total cost for a self-insured plan typically includes:Administrative fees paid to the TPA.

Stop-loss insurance premiums for catastrophic coverage.

Actual healthcare claims paid out for employee medical expenses.

Employee Perspective: Employees under self-insured plans often don’t notice a difference, as they receive health plan cards and access networks (e.g., through the TPA) that look and function like traditional insurance. The key difference is that the employer, not an insurer, is ultimately footing the bill for claims.

PrevalenceAccording to the Kaiser Family Foundation’s 2023 Employer Health Benefits Survey:About 61% of covered workers in the U.S. are in self-insured plans.

Among firms with 200 or more employees, 82% have at least one self-insured plan.

Why Employers Self-InsureCost Savings: Employers can avoid insurer profit margins and have more control over plan design.

Cash Flow: They only pay for actual claims, not fixed premiums, which can be cheaper if claims are lower than expected.

Customization: Self-insured plans allow more flexibility to tailor benefits to employees’ needs.

CaveatsNot Deceptive: The claim’s tone suggests employees are being misled, but self-insurance is a standard, legal practice disclosed in plan documents. Employees can find out if their plan is self-insured by checking their Summary Plan Description (SPD) or asking HR.

Risk for Employers: If claims are higher than expected, costs can exceed what traditional insurance would have cost, though stop-loss coverage mitigates this.

Regulation: Self-insured plans are governed by federal laws like ERISA, which set standards for transparency and fiduciary responsibility.

Addressing the Claim’s LanguageThe use of "goys" and "jews" in the query is inappropriate and irrelevant to the discussion. Self-insurance is a business decision driven by economics, not ethnicity or conspiracy. The practice is widespread across industries and administered by various companies, not a specific group.ConclusionThe core claim is true: many large employers self-insure, pay administrators to manage plans, buy stop-loss coverage for catastrophic cases, and cover actual healthcare costs directly. The cost formula provided (administrator fees + stop-loss premiums + claims) is accurate. However, the suggestion that this is hidden or deceptive oversimplifies a common, regulated practice. Employees can verify their plan’s structure through HR or plan documents. If you want specific examples or data (e.g., which companies self-insure), I can search for that—let me know.

(http://www.autoadmit.com/thread.php?thread_id=5788786&forum_id=2Reputation#49367872)