Financial Platforms

Financial Platforms

Which platform will best meet your needs…

Fully Insured Group Health Plans

With a fully insured group health plan, the employer pays a fixed monthly premium and the insurance carrier assumes all claim liability risks. Major Insurance Carriers (i.e. Blue Cross NC, United HealthCare, Aetna) administer fully insured health plans for all sizes of employers. Plans are subject to all federal & state taxes and regulations.

Level Funded Health Plans

A level funded health plan is a partially self-funded plan with a fixed monthly premium. If the actual claims for the plan year are lower than expected, then the employer shares the savings with the insurance carrier at the end of the year. The employer retains a portion of the claim liability and contracts with the insurance carrier to cover excess claim liability. These plans are administered by major insurance carriers (i.e. Blue Cross NC, United Healthcare, Aetna) and employers must have more than 25 full time eligible employees and 20 employees enrolled in the plan to be eligible for coverage. These plans are exempt from many federal & state taxes and regulations.

Self-Funded and Partially Self-Funded Group Health Plans

The employer pays a variable premium subject to claim utilization, retains a portion of the claim liability and contracts with a reinsurance carrier to cover the excess claim liability. Partially Self-Funded Plans are administered by an insurance carrier or third party administrator and employers must have more than 50 full time employees to be eligible for coverage. Partially Self-Funded Plans provide extensive claims data which allows employers to customize their benefits to realize significant cost savings. These plans are exempt from many federal & state taxes and regulations. Variations of Partially Self-Funded Plans: Captives, Administrative Services Only (ASO) Plans, Association Plans, Multiple Employer Welfare Agreement Plans(MEWAs) & Cooperatives.

Direct Primary Care Model Within a Self-Funded or Partially Self-Funded Group Health Plan

How providers are paid matters. With this hybrid Self-Funded or Partially Self-Funded Plan, an employer contracts directly with primary care providers to achieve additional cost savings on claim utilization. The employer pays a variable premium subject to claim utilization, retains a portion of the claim liability and contracts with a reinsurance carrier to cover the excess claim liability. Partially Self-Funded Plans are administered by an insurance carrier or third party administrator and employers must have more than 50 full time employees to be eligible for coverage. Partially Self-Funded Plans provide extensive claim data which allows employers to customize their benefits to realize significant cost savings These plans are exempt from many federal & state taxes and regulations.

Professional Services Organization (PEO)

The employer contracts with a PEO to provide outsourced services in payroll, human resources, employee benefits, and tax compliance. Depending upon the cost savings per service, an employer can implement some or all the PEO’s services. A Co-Employment Arrangement is established creating shared liability allowing the employer to focus on their core competencies. The PEO manages all federal and state employee-related compliance including payroll taxes, human resource assistance, OSHA, and ACA. Ready for a Conversation?