What are level-funded plans, and why are they becoming so popular? Allow this article to break down the facts for you.
A brighter light is being cast on level-funded group health plans as benefits decision-makers tackle open-enrollment season. Several industry observers say the trend is more pronounced given that the Affordable Care Act remains largely intact — for now.
There has been an ebb and flow to these self-insured underwritten plans over the past 18 months, says Michael Levin, CEO and co-founder of the healthcare data services firm Vericred. But with a fixed monthly rate for more predictability, he says they can drive 25% to 35% savings relative to fully-insured ACA plans that must comply with the medical loss ratio for a certain segment of the market.
Level funding typically leverages an aggregate and/or specific stop-loss product to cap exposure to catastrophic claims. These plans are offered by an independent third-party administrator or health insurance carrier through an administrative-services-only contract.
It’s best suited for companies with a very low risk profile comprised of young or healthy populations, according to Levin. And with low attachment, stop-loss coverage in most states, he explains that the plans have “very little downside risk from the group’s perspective.” Two exceptions are California and New York whose constraints on the stop-loss attachment point “essentially preclude level-funded plans from being offered” there, he adds.
The arrangement is trickling down market. “We’ve heard from carriers that will go down to seven employees, plus dependents, while others cut it off at 20 or 25,” he says.
David Reid, CEO of EaseCentral, sees a “resurgence of level funding” across more than 38,000 employers with less than 500 lives that his SaaS platform targets through about 6,000 health insurance brokers and 1,000 agencies. His average group is about 30 employees.
He’s also seeing more customers using individual-market plans rather than group coverage through Hixme’s digital healthcare benefits consulting platform. Under this approach, health plans are bundled with other specific types of insurance and financing as a line of credit to fill coverage gaps. Employer contributions are earmarked for individual-market plans, which are purchased through payroll deduction.
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Source: Shutan B. (17 November 2017). "Level-funded plan uptake trickling down market" [Web Blog Post]. Retrieved from address https://www.employeebenefitadviser.com/news/level-funded-plan-uptake-trickling-down-market?feed=00000152-175e-d933-a573-ff5ef1df0000