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FAQ'S
Your life, Our answers
Explore our plans to learn more about your healthcare options and in addition receive a quote from us.
Fixed costs typically include TPA Fees, Network Fees which include Utilization Review/Case Management, Program Management Fees, and Producer Compensation (as applicable).
Funding is paid monthly into the Employer’s Claim Fund. For incurred claims the Employer Claim Fund is used to pay those adjudicated claims. At the end of the contract term, normally referred to as the run-out period, the TPA will conduct
an audit of the Employers Claim Fund. Depending on the surplus option selected during plan implementation, claims dollars could be reimbursed back to the employer.
Groups, from their effective date, are written on a 12-month incurred and 18 months paid (12/18) contract.
Most of our plans are priced on a Reference Based Reimbursement model. For those who need a network option to quote our standard PPO network is First Health.
If an employer offers two (2) plans to their employees both plans must be on the same network pricing – i.e., both plans must be on Reference Based Reimbursement, or both must be on the PPO network.
Any remaining claims dollars will be returned to the employer client following the run-out period.
Yes, we have several plans that are HSA Eligible.
How do Level Funded Plans Work?
The level funded plans have a minimum aggregate stop-lost attachment point. The minimum annual aggregate deductible is based on a pre-determined percentage of the annual aggregate deductible, calculated by the greater of the quoted enrollment or the first month’s enrollment multiplied by the monthly aggregate factor(s) and then multiplied by the number of contract months (normally 12 months). If a group has a significant reduction in enrollment during the contract year, it could result in increased liability and contribution of additional funds by the plan if the minimum attachment point is not met.
Maximum Costs vs. Expected Costs – Maximum costs are the underwritten administration costs plus claims and stop-lost premiums. Expected costs are roughly 80% of the maximum, or the average cost an employer might expect to see.