Level-Funded Group Health Insurance Plans
Straightforward Health Benefits for Your Workforce
What Are Level-Funded Group Health Insurance Plans?
Level-funded group health plans are gaining traction as an alternative to traditional fully-insured and self-funded health insurance. These plans combine the predictability of fixed monthly payments with the potential cost savings of self-funding, making them an attractive option for small to mid-sized businesses.
Employers pay a fixed monthly amount that covers three components:
- Administrative Costs: Includes third-party administration (TPA), network access, and customer support
- Claims Funding: Allocated for employee healthcare claims
- Stop-Loss Insurance: Protects against catastrophic claims by capping the employer’s financial risk
If claims are lower than anticipated, employers may receive a refund of unused funds at the end of the coverage year. Conversely, if claims exceed the funded amount, the stop-loss insurance covers the overage, ensuring financial predictability.
Benefits of Level-Funded Plans
There are a few different advantages to having a level-funded insurance plan:
- Claims Transparency: Employers gain access to anonymized claims data, enabling them to identify trends and implement cost-saving strategies.
- Cost Predictability: Fixed monthly payments eliminate the uncertainty often associated with self-funded plans.
- Flexibility: Employers can customize the benefits of a level-funded plan to suit their workforce’s needs.
- Lower Costs: Level-funded plans often have lower premiums than fully-insured plans, especially for healthy employee groups.
- Refund Potential: Employers may receive a refund if claims are lower than anticipated, providing an opportunity for savings.
What Kind of Employer is the Best Fit for Level-Funded Plans?
Level-funded plans are best suited for:
- Cost-Conscious Employers: Those who are seeking predictable costs with the potential for savings
- Growth-Oriented Companies: Organizations that want the flexibility to scale benefits as they expand
- Healthy Workforces: Employers with low healthcare utilization rates can maximize refund opportunities
- Small to Mid-Sized Businesses: Companies with 10 - 200 employees looking for an alternative to fully-insured plans