HEALTH PLAN FUNDING OPTIONS

We offer a variety of funding options to meet the diverse needs of companies we serve.

Fully-Insured and Level-Funded

  • Traditional plans managed by insurance carriers.
  • Insurance carriers charge a fixed monthly premium based on estimated claims and administrative costs.
  • The monthly premium changes once per year, at renewal, with the only variation during the year driven by changes in enrollment.
  • Plan designs, pricing, and claims administration are controlled by the insurance carrier.
  • Suitable for small to mid-sized employers with limited cash flow and lower risk tolerance.

Preferred Risk Pools – Consortia and Captives

  • Small to mid-size employers band together to use their collective size to buy health benefits mimicking the predictability and bulk buying power of larger companies.
  • Stop loss insurance protects employers from high claims and caps monthly cash flow.
  • Plan designs can be customized.
  • Depending on the arrangement, there may be flexibility to select specialized vendors such as disease management concierges, enhance primary care, and transparent Pharmacy Benefit Managers (PBMs).
Health Plan Funding Options

Health Plan Funding Comparison

FULLY INSURED LEVEL FUNDED CONSORTIUM CAPTIVE
Suitability – Best for Companies with 2-50 Employees 10-50 Employees 20 or More Employees 50 or More Employees
Cash Flow Stability Fixed Monthly Fixed Monthly Capped Monthly Capped Monthly
High Claim Financial Protections Yes Yes Yes Yes
Control Carrier Carrier Employer Employer
Claim Fund Surplus Disposition To Carrier Shared between Carrier and Employer * To Employer To Employer
Ability to Customize Health Plan No No Yes Yes
Access to Actionable Claims Data No Limited Yes Yes
Cost Management Carveouts and Overlays Permitted No No Yes ** Yes

* Claim Fund Surplus only shared with employer if they renew with the carrier.
** Depends on TPA, Vendors, and Group Size

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