The New Age of Healthcare: Benefits of Level Funded Health Plans

Friday, June 9, 2023 05:58 Posted by Admin

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As health care costs continue to soar, businesses worldwide are searching for innovative health insurance solutions that balance quality health benefits and financial risk. Among the myriad of options available, level-funded health plans have gained traction and popularity. These self-funding health insurance solutions provide an optimal balance, enabling businesses to manage healthcare expenses while still offering substantial health benefits to their employees. This article, presented by Taylor Benefits Insurance Agency, aims to delve deeper into the operational mechanics and benefits of level funding health plans.

The Growing Popularity of Level Funded Health Plans

Traditional insurance plans typically involve high costs with limited flexibility for employers. Recognizing the need for a more balanced approach, many businesses are gravitating towards level funded plans. This self-funding model offers a unique blend of the predictability of a fully insured plan and the cost-saving potential of a self-funded plan.

The Mechanics of Level Funding

The core concept of level funding revolves around self funding. Here’s how it works: instead of paying a predefined premium to an insurance company, businesses pay a fixed amount each month into a fund earmarked for potential health claims included in their group health plan. This amount also includes a fee for stop loss insurance and administrative services.

Leveraging Stop-Loss Insurance for Financial Security

A defining feature of level funded plans is the integration of stop loss insurance. This type of insurance provides financial protection to employers, safeguarding them against unexpectedly high claims. In the event an employee has major health issues, the stop loss insurance kicks in to cover costs above a predetermined amount, capping the employer’s financial risk. This ensures businesses aren’t crippled by high-cost claims while still being able to provide comprehensive health benefits.

Level Funded Plans: A Smart Business Strategy

Level funded plans have emerged as a smart business strategy for companies seeking to optimize their healthcare expenses. They offer greater control over costs compared to fully insured plans, while the stop loss insurance ensures financial risk is contained. Moreover, the potential to get a refund on unused funds at the end of the year makes level funding a financially appealing choice for many businesses.

In this new age of healthcare, level funded health plans have surfaced as a viable health insurance solution for businesses. Offering a balance between substantial health benefits and controlled financial risk, they are a smart choice for employers. To understand more about level funding and how it can benefit your business, feel free to contact Taylor Benefits Insurance Agency. As a trusted provider, we’re well-equipped to help you navigate your options and find a plan that suits your needs.

Understanding Level Funded Plans

Level funded plans operate as a middle ground between traditional fully insured plans and self-funded plans. In a level funded plan, the employer pays a fixed monthly fee to an insurance company or third-party administrator, which includes administrative costs, stop-loss insurance, and an amount set aside to pay expected claims.

Unlike a fully insured plan, where employers pay a fixed premium regardless of actual claims, level funded plans allow for greater financial flexibility. If actual claims are lower than expected claims, employers can benefit from the unused claims dollars. This unique characteristic of level funded plans helps to contain health care costs, making them an attractive option for small to mid-sized businesses.

Balancing Risk with Stop-Loss Insurance

A crucial aspect of the self-funding model, especially in the realm of level funded health plans, is the integration of stop-loss insurance. This type of coverage serves as a critical safety net, protecting employers from financial repercussions linked to higher than expected claims.

In a self-funded health plan, the employer takes on the role of an insurance company, assuming the risk of providing health benefits to employees. Essentially, instead of paying premiums to an insurance carrier, the employer sets aside funds to cover potential health care claims. While this approach offers numerous benefits, such as cost savings and more control over health plans, it also exposes the employer to potentially significant financial risk if employee claims exceed the allocated funds.

This is where stop-loss insurance steps in, addressing this risk associated with self-funded plans. In essence, it’s an insurance policy for the employer’s insurance. For instance, if an employee needs emergency room care, has a catastrophic health event, or if the cumulative claims from all employees are higher than expected, stop-loss coverage takes effect. It caps the employer’s liability, ensuring that costs associated with such unforeseen events do not exceed a certain limit pre-decided in the insurance policy.

This type of coverage, thus, plays a vital role in maintaining the financial stability of companies opting for self-funded insurance plans. It allows them to take advantage of the flexibility and potential cost savings of a self-funded plan, while mitigating the inherent financial risks. This makes stop-loss insurance a vital cog in the wheel of the level funding insurance model, ensuring that businesses can provide robust health benefits without the fear of unpredictable healthcare costs destabilizing their finances.

As such, the incorporation of stop-loss insurance into self-insured health plans underpins the successful operation of level funded plans. It allows employers to adopt the self-funding approach with confidence, safe in the knowledge that they have a financial backstop in place.

The Role of Third-Party Administrators

A level funded health plan typically involves a third-party administrator, who takes over administrative tasks such as managing employee claims and benefits consultations. This arrangement frees the employer from these administrative burdens, enabling them to focus on core business functions while reaping the benefits of self-funding.

Cost Containment Strategies and Wellness Programs

A standout feature of level funded health plans is their capacity for promoting proactive cost containment strategies. Unlike traditional fully insured large group plans, a self-funded insurance model provides employers with direct access to comprehensive claims data. This level of transparency can prove invaluable in the context of financial management and health care optimization.

With access to this data, employers can identify and analyze trends in their employees’ healthcare usage, such as frequent visits to the emergency room or a high volume of certain medical claims. Recognizing these patterns allows employers to implement targeted wellness programs designed to improve overall employee health and, consequently, reduce the frequency and cost of claims.

Thus, by leveraging claims data and initiating wellness programs, businesses adopting level funded plans can enjoy a more proactive, hands-on approach to managing their healthcare costs. Through these strategies, they can enhance the health and wellbeing of their employees while also ensuring financial stability and sustainability in their health insurance offerings.

Predictable Expenses and Cash Flow Benefits

One of the standout advantages of a level funded health plan is the financial predictability it brings to employers. When businesses opt for a self-funded insurance model like level funded plans, they pay a fixed monthly fee to the insurance carrier. This fee is calculated based on an estimate of the anticipated health care costs for the year. This arrangement results in predictable monthly expenses, simplifying budgeting and financial forecasting.

Beyond predictability, level funded plans offer an additional cash flow benefit. In the scenario where actual health care claims are lower than expected over the course of the plan year, the insurance carrier often provides a surplus refund to the employer. This feature enhances the attractiveness of self-funded plans by not only providing predictability but also the opportunity for cost savings.

Therefore, adopting a level funded health plan can significantly improve cash flow management for businesses. It mitigates the unpredictability often associated with self-funded insurance and offers a financially prudent route to providing robust health coverage.

Employee Benefits in Level Funded Plans

Employees stand to gain significantly from the adoption of a level funded health plan by their employer. These self-funded plans strive to provide comprehensive health coverage on par with traditional fully insured models. In fact, the level of health benefits found in these plans often surpass expectations.

Under the umbrella of a level funded plan, employees can expect coverage for a wide range of medical services. This includes physician and hospital services, emergency room visits, and other essential employee health benefits. As such, level funded insurance positions itself as a promising solution to delivering comprehensive health care benefits while managing costs effectively.

Final Words

Selecting the right health plan for your business requires careful consideration of many factors, including the size of your business, your financial capacity, and the healthcare needs of your employees. A level funded plan can offer the cost-saving benefits of self-insurance with the financial protection of a fully insured plan.

In conclusion, level funded health plans can provide a balanced solution for employers seeking to manage healthcare costs while still providing quality health benefits to their employees. Understanding the mechanics and benefits of these plans is the first step towards making an informed decision about your company’s health insurance.

If you’re considering a transition to a level funded plan or have further questions about health insurance costs and options, don’t hesitate to reach out to Taylor Benefits Insurance Agency. Our team of experts is always ready to guide you through your options and help find the best health insurance plan for your business.

Written by Todd Taylor

Todd Taylor

Todd Taylor oversees most of the marketing and client administration for the agency with help of an incredible team. Todd is a seasoned benefits insurance broker with over 35 years of industry experience. As the Founder and CEO of Taylor Benefits Insurance Agency, Inc., he provides strategic consultations and high-quality support to ensure his clients’ competitive position in the market.

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