Healthcare

Fully Insured

Employers with 2-99 employees are considered a ‘small group’ and are provided age-banded rates based on an enrollee’s age and the organization’s zip code. With the onset of the Affordable Care Act in 2014, all policies are standardized and guaranteed issue with no pre-existing condition clauses.

Employers with 100 or more employees are considered a ‘large group’ and are provided composite rates that take into account the group’s demographics along with their medical history. Composite rates provide a single rate for all employees regardless of age, with three additional variations for dependents. Plan customizations vary by insurance carrier to meet your specific needs.

Self Funded

Larger employers that want to take on the risk of medical claims can take control over costs by self funding and fully customizing plan designs. This enables the employer to either partner with an insurance carrier or third party administrator to coordinate care through a network of their choice and implement individual and aggregate stop loss policies against the inherited risk.

An alternative to tackling the self funded model alone would be to take part in a health captive that pools employers together to distribute the risk.

Level Funded

A hybrid between fully insured and self insured, the level funded model allows an organization to take advantage of a low claims year with the potential for a refund. As a stepping stone to self-insuring, an organization can begin to garner insight on their overall claims experience. This avenue also opens the door for small group employers down to 25 enrollees to offer composite rating and customized plan designs.