Level Funded Health Plans

Since Obamacare, ACA, the future of fully insured health plans is bleak. The restrictions on health insurance companies, ACA compliance, plus ramifications on employers who buy fully-insured employee health coverage are driving unsustainable cost increases. The ACA MLR provisions encourages fully insured carriers to increase healthcare claim payments

Maximize the Competitive Value of Your Employee Benefits

EXPLAINATION: the Median Loss Ratio (MLR) requirements will limit insurers to only 15% of premium dollars for non-medical expenses. Claims paying accuracy and service diminishes. Employers resent getting less and the extra costs as simply more expense.

What is going on is sad and unfair...but it is now entrenched, and traditional small group health insurance (under 50 employees) will become the high risk pool. On the brighter side, several years ago, several innovators foresaw the possibility of the market in the US for fully-insured health policies & plans disappearing. ERISA (self-insurance) provides new opportunities for employers to craft their own group health benefits. Today, healthy and insurable employers will move into Level Funded Self-Insured solutions, but be forewarned, not all solutions are compliant, legal, perform or are better. You have to be able to fully vet your TPA’s product.

By definition, self-funded plans, have no profits, are required to have fiduciary protections, so many the punitive restrictions forced on fully insured health insurance companies do not apply. Also, there is much more control & flexibility for employers to design and administer their plans for the wants & needs of each particular workforce. So, the kinds of controls, limits and governmental second-guessing are not involved.

If your goal is to find the best and more affordable ways of providing competitive, value-based benefits; we are your obvious choice.

We help employers design a systemic approach for making a strategic investment in employee benefits that recalibrates the allocation of existing dollars and resources to gain a greater competitive advantage.

Creating a benefits agenda/benefits business plan that identifies priorities, maps the path and delivers results for today as well as tomorrow is the key challenge for companies.

Group Benefits Experts delivers the consulting and analytical services needed to manage the delivery of your health care benefits. We become your outsourced HR department. Our deliverable helps to cure medical illiteracy and improves adherence to evidence-based medicine. Disease treatment compliance improves and healthcare need is reduced. All of our solutions target 100% of your employees and their covered spouses. Financial and clinical outcomes are improved, reported from your healthcare data. We work as commissioned consultants or on a revenue share model based on the savings we create in your health care benefit plan.

Level Funding; Self Insurance with a "Safety Net"
Advantages of Self-funding under the Affordable Care Act

Self-funded plans exempt from many costly new mandates and state taxes
Many ACA provisions do not apply to self-funded plans
Ability to customize plan designs
Higher probability of reducing cost & trend of medical benefit expense
Wellness and member engagement programs have a direct impact on reducing claims costs

Level-Funded & Self-Funded Health Plans with Integrated Wellness Administration
Integrated Wellness Administration & Incentive Management

Reference Based Pricing / Claim Auditing / Fiduciary Model
100% Transparency / Fiduciary Model
100% of Pharmacy Rebates go to Plan Sponsor
Self-insured and Self-insured with a safety net Level Funding
Health plans combined with Benefit, Wellness, and Incentive administration

End of year refunds; the balance in your claims account is 100% yours, dictated by law!


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Veridence 365

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Group Benefits Experts

PO Box 531778
Cincinnati, OH 45253