Self/Level Funding


Self/Level-Funding has been around for many years and a majority of large employers have found that it is the most cost effective way to provide employee benefits to their employees. Since 2010, many insurers offer risk transfer products for smaller employers, thus enabling them to take advantage of the benefits of self funding without assuming a huge financial risk. In most cases, smaller employers are able to budget the same costs under self funding that they would have paid had they remained fully insured except now they get money back when they have lower claims!


Advantages of Level-Funded Plans

  • Set monthly payments
  • Limited liability through stop-loss insurance
  • Stop-loss advancements
  • Retain unused claim funds
  • Long-term savings
  • Tax Savings





About your proposed rates…
The rates provided are contingent rates subject to underwriting review and/or approval. Rates quoted include a rate load to offset potential medical issues found during the underwriting process.

Underwriting process…
Depending on the carrier(s) quoted, the carrier may offer one or more of the following underwriting methods:

  • Paper Application
  • Online Application
  • Telephonic Interview

Rate Calculation...
The carrier(s) will look at the conditions of the employees to determine which conditions are considered to be "ongoing" into the next plan year. They then only use those conditions that are anticipated to generate claims to determine how much is anticipated to exceed the average daily claim usage.


Carrier:
Carrier A
Carrier B
Plan:
Traditional PPO
CDHP Plan
Deductible**:
$1,500
$1,500
Out-of-Pocket Max**:
$5,000
$5,000
Member Co-Insurance:
20%
20%
Primary Care Office Visits:
$25
deductible/coinsurance
Teledoc Benefit:
$25
$40
Urgent Care:
$40
deductible/coinsurance
Emergency Room:
deductible/coinsurance
deductible/coinsurance
Hospitalization:
deductible/coinsurance
deductible/coinsurance
Outpatient Surgery:
deductible/coinsurance
deductible/coinsurance
Labs & X-Rays:
deductible/coinsurance
deductible/coinsurance
Rx Deductible:
$150
n/a
Prescription Benefit:
$15/$45/$75
deductible/coinsurance

Rate Summarization
Number
of Units
Rate TypeFully Insured
Renewal Rates
Level-Funded
PPO Plan
Level-Funded
CDHP Plan
107Employee:$525.15$494.73$435.55
42Dependent:$777.22$732.07$646.72
Monthly Premium:$88,834.37$83,682.93$73,766.07
Annual Premium:$1,066,012.49$1,004,195.16$885,192.84
Gross Annual Savings:$61,817.33$180,819.65
Plus - projected claims fund refund:$69,645.00$58,802.28
Projected Net Annual Savings:$131,462.33$239,621.93