Solutions
Fully insured, level-funded and self-funded plans differ in how you pay, who carries claims risk and how much control you have over plan design. Compare them before narrowing the field.
Specific products and availability are subject to confirmation.
Greater certainty. Covered claims backed by an insurer.
With a fully insured group medical plan, the employer pays premiums and the insurance company assumes responsibility for covered medical claims under the policy.
Important consideration: Premiums may change at renewal, and total payments can change with enrollment. The policy determines covered services and exclusions.
Predictable monthly funding. Potential to benefit from lower claims.
Level-funding is a form of self-funding that combines expected claims funding, administration fees and stop-loss premiums into regular monthly payments.
Important consideration: Surplus refunds, funding obligations, renewal terms and stop-loss protection depend on the contracts. Savings are not guaranteed.
Greater control over your health plan and healthcare spending.
With a self-funded plan, the employer funds covered medical claims. An administrator can manage claims and plan operations, while stop-loss insurance can protect against specified high-cost exposure.
Important consideration: Claims costs can fluctuate. The employer retains funding and plan responsibilities, and stop-loss protection is subject to its terms.
A benefit-design choice discussed within the level-funded and self-funded range, not a fourth funding model. Limited-day plans place specified limits on certain medical benefits, such as covered hospital days or visits.
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Limited-day coverage is not the same as comprehensive major medical coverage. Services beyond the stated limits may not be covered. Minimum essential coverage and minimum-value status must be confirmed for the specific plan.