KBenefits Insurance Services
Level-Funding Self Insured

Level-Funded Self-Insurance

Employers.  Gain control of your health care expenses while providing quality benefits to your employees. By combining the cost savings of self-funding with the stability of more traditional plans, self-funded plans gives you the simplicity and cost savings you’re looking for without the hassle of administering the program yourself.
 

How it works? Monthly premiums are sent to an insurance carrier.  A "claims bucket" is created to pay for future employee medical claims.  The carrier adminsters the plan and purchases additional stop-loss insurance to help cover claims in the event claims exceed the funded "claims bucket". 

 

If funds are not depleted during the year, then the employer has an opportunity for a return of premium, percentage of the unused claims bucket.

Explore the best selling offers

Horizon Level Select is for employers with 15  to 99 employees. Three plan options:  OMNIA, Advantage EPO & Direct Access - includes Rx  & wellness benefits.

 

With level-funding plans, employers:
• Pay the actual claims, plus an administrative fee
• Receive a portion of excess funds as a refund
• Built-in protection with stop-loss coverage.
• Include individual and aggregate stop-loss protection


Cost-saving opportunities.  If claims are lower than expected, groups will receive 50% reimbursement of the surplus — so a healthier employees means cost savings.

Healthier employees.  Built-in wellness tools and end-of-year reporting.

BlueCard® coverage.  Get in-network out-of-state coverage

Health Savings Account (HSA).  With a high-deductible health plan, covered members enjoy pretax savings they can use to pay for qualified medical expenses.

United Healthcare Level Funded plans are available to employers with 2-99 and 100-300 employees. Freedom, Liberty and Metro networks available. 

 

National network – UHC Choice/Choice Plus, UHC Navigate®/UHC Charter® or UHCCore/Core Essential.

• $0 Primary Care Physician Copays for Kids program*.


• Monthly employer claims and utlization reporting.

• Choice of Prescription Drug Lists – Advantage or Essential.

• Surplus refund for the plan sponsor if medical claims are lower than expected.

• 24/7 access to virtual care providers with Virtual Visits and Healthiest You.

• Simplified contract - no back-end claim exposure for the plan sponsor; no terminal liability requirements or deficit carry-forward.

• Low individual and aggregate attachment levels to limit claim exposure. Larger stop loss for larger groups

• Individual Stop Loss up to $100,000  (varies by state)
• Aggregate Stop Loss of 110%, 115%, 120% and 125%

Aetna Funding Advantage built for small businesses. It has one stable monthly payment, the opportunity to get money back when claims are lower than expected and the protection of stop-loss insurance when claims are higher than expected.

 

Aetna AFA offers 54 health plan options, health/wellness programs, digital benefits admin and broad & enhanced local network options.

 

Employers must contribute 50% to the total cost of coverage of the lowest cost plan option or 50% of employee only contributions for the cost of coverage of the lowest cost plan option. Depending on the # of eligible employees your organizations has, Aetna requires a certain # of those employees to enroll.. Once you have 10 eligible employees, a minimum of 50% of eligible employees must enroll in the plan.

Allstate Benefits

Level-funding and Reference-based price plan options for 2-50 employees offer national networks with Aetna ASA and Cigna PPO.

  • Refund always returned upon renewal or termination
  • 100% surplus option
  • Will enroll: 1099 groups, Husband/wife groups and Owners-only enroll groups



Level-Funding options:

PPO:  A plan that pays benefits for both innetwork and out-of-network services, with secured network savings.

Advantage Plans:   A plan that pays benefits for emergency and in-network services only. Savings come from eliminating the high costs of out-of-network services.  Access to National Networks with In Network Benefits only.

Copay Plans:  Simple copay plan options without high deductibles and high out-of-pocket expenses. Zero-Deductible and HSA-Compatible plans are available.


 

Reference-Based pricing options:

Core Value:  A reference-based pricing plan that pays based on a multiple of the Medicare reimbursement rate, delivering great savings potential.

Core Value Access:   Core Value Access gives clients the savings of a reference-based pricing plan with the added benefit of access to a network for physicians.

Core Value Flex:  This option allows employers to experience the savings of our Core Value plan with the added flexibility of switching to a PPO network mid-year, without a change in your clients’ monthly payment.

 

Terminal Liability Coverage:
Provides added protection for claims that come in for 24 months after the end of the plan year – and is included with most plan selections

 

Minimum Essential Coverage (MEC):   MEC plans provide access to preventive and wellness care benefits that meet the ACA requirements for minimum essential coverage.  MEC Care or MEC Preventive

 

 

Contact us for questions, plan options and free enrollment assistance.

Christopher S. Kudryk
chris@kbenefits.com
732-333-1976

Christopher S. Kudryk
Insurance Specialist
chris@kbenefits.com
732-333-1976

KBenefits Insurance Services provides insurance solutions for small business owners and individuals in New Jersey, New York, Penn and Florida..

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