Self-insured carriers:
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
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