Make a worry-free transition from a fully insured to a self-funded health plan
Create® Level Funded combines the predictability of a fully insured plan with the cost savings of a self-funded health plan.
Small and medium-sized businesses have a few options when it comes to funding health benefits and offering the best plans. Some choose to fully insure their employee benefits plan for the predictable monthly payment. But fully insured plan design is typically inflexible and restrictive, and cost containment programs may be less than effective or even unavailable.
Self-funding is an alternative approach to financing an employee benefits plan. It’s an attractive option for businesses that want to lower costs and maintain full control over all aspects of their operation.
Large employers have long used self-funding to directly fund their anticipated claims, while separately purchasing Stop Loss insurance to protect against unexpected claims. However, traditional self-funding doesn’t provide the predictable monthly payments that smaller businesses prefer.
Benefits of Create®Level Funded
- No surprises: Monthly costs don’t fluctuate. They’re based on the number of covered members and cover all eligible claims, fees and Stop Loss premiums.
- Money back in your pocket: You can get a return of your monthly payments if they exceed your actual spend.
- Detailed reporting: You can easily track how claim dollars are being spent.
- Elimination of most premium tax: There is significantly less premium tax on self-funded benefits plans, which immediately results in approximately 2-3% cost savings for the plan.
- Control over benefit dollars: You know where your funds are going and what they’re used for. If eligible medical claims for a plan year do not exceed a predetermined limit, the plan keeps those dollars and they can be used to offset the following year’s expenses or reduce contribution levels.
- Easier admin: Create pays eligible claims, decides appeals and handles other administrative tasks.
- Lower operational costs: Overall administrative costs for a self-funded program incurred through a professional TPA such as Create are usually lower than costs charged by the insurance carrier.
- Cost-effective claim processing: Create’s success is built on providing accurate and controlled claim processing for each employer.
- Savings on carrier profit margin and risk charge: The insurance carrier’s profit margin and risk charge are eliminated for most of the plan.
- No state mandate costs: Self-funded plans are subject only to the federal Employee Retirement and Income Security Act (ERISA). State laws and regulations that require you to provide various benefits or comply with other administrative requirements do not apply.
- Better cost and utilization control: A variety of cost control programs may be available, such as large case management, second surgical opinion and outpatient surgical and hospital bill audit programs, rather than being restricted to an insurance company’s limited in-house programs.
- Flexible managed risk through Stop Loss coverage: You determine the amount of retained risk and the amount of risk to be covered by the Stop Loss coverage.