Self-insured Employer's Plan for Managed Care - South Dakota

Self-insured Employer's Plan for Managed Care is a legal document that was released by the South Dakota Department of Labor & Regulation - a government authority operating within South Dakota.

FAQ

Q: What is a self-insured employer's plan?
A: A self-insured employer's plan is a healthcare plan where the employer takes on the financial risk of providing healthcare benefits to its employees.

Q: What is managed care?
A: Managed care is a healthcare delivery system that aims to control costs and improve quality by emphasizing preventive care, coordination of services, and cost management.

Q: How does a self-insured employer's plan for managed care work?
A: In a self-insured employer's plan for managed care, the employer hires a managed care organization (MCO) to administer the healthcare benefits for its employees. The MCO negotiates with healthcare providers to provide services at discounted rates and coordinates the care to ensure cost-effective and quality treatment.

Q: Is a self-insured employer's plan available to all employers in South Dakota?
A: Yes, self-insured employer's plans are available to all employers in South Dakota, regardless of their size.

Q: What are the benefits of a self-insured employer's plan for managed care?
A: Some benefits of a self-insured employer's plan for managed care include potentially lower costs for employers, greater flexibility in plan design, and access to a network of healthcare providers.

Q: Are employees covered under a self-insured employer's plan for managed care?
A: Yes, employees are covered under a self-insured employer's plan for managed care. They receive healthcare benefits provided by the employer through the managed care organization.

Q: Do employees have to pay premiums for a self-insured employer's plan?
A: The payment of premiums for a self-insured employer's plan varies depending on the employer's plan design. Some employers may require employees to contribute towards the cost of premiums, while others may cover the full cost.

Q: Is there a specific network of healthcare providers for a self-insured employer's plan?
A: Yes, a self-insured employer's plan for managed care typically has a network of healthcare providers with whom the managed care organization has negotiated discounted rates. Employees are encouraged to use the providers within the network to maximize cost savings.

Q: Can employees choose their own healthcare providers with a self-insured employer's plan?
A: Employees may have some freedom to choose their own healthcare providers within the network established by the managed care organization. However, using providers outside of the network may result in higher out-of-pocket costs.

Q: What happens if an employee needs care from a specialist?
A: If an employee needs care from a specialist, they would typically require a referral from their primary care provider, as is common in managed care plans. The managed care organization can help coordinate the referral and ensure the employee receives appropriate care.