Shared funding

Are you an employer with more than 100 employees? Do you think your employees are healthier than the insurance premiums you've been paying?

Consider shared funding, Priority Health's innovative new funding structure that could lower your health care costs and, based on usage, reimburse you for unused premium.

Shared funding defined

Shared funding blends the traditional features of a fully funded health plan with the rewards of a self-funded arrangement. You pay all claims for your members while receiving excellent health care and plan administration services from Priority Health. If your usage is not as high as predicted, you are reimbursed the difference between usage and premium paid. You assume more of the risk with shared funding, but you also have the potential to reap significant rewards.

How shared funding works

1. Priority Health works with you to choose a benefit design and determine an annual premium based on your group's claims history.
2. Then we add administrative and stop-loss coverage fees to get your total annual premium. We divide this into monthly payments for easy bookkeeping.
3. At the end of the plan year, Priority Health will compare your actual claims to the total premiums you've paid.
   
   • If your claims are lower than your paid premiums, we'll refund you the difference.
   • If your claims are higher, you'll owe us the difference, but only up to a ceiling amount we agree upon at the beginning of the plan year.

Shared funding features

Detailed and transparent reporting

You receive regular financial and usage reports throughout the year. Our reports are:

• Accurate
• Comprehensive
• Group specific
• Delivered electronically in a secure environment

See guides to our shared funding reports.

Network discount and utilization guarantees

• Average discount with participating providers is 41%-48%
• Average prescription discount is 20% for brand-name drugs and 70% for generic drugs
• Discount and in-network utilization guarantees offered based on region or group size

Service performance guarantees

• 98% percent of all claims processed electronically; 99% are processed accurately
• 96% percent issues received by our call center are resolved on the first call
• Average speed to answer is 38 seconds
• Only 2.4% of calls abandoned, compared to industry standard of 4%

Health management

Take advantage of our wellness class offerings and other health management services to help keep costs in check.


Compare shared funding with Priority Health's other funding options.

Contact the sales representative for your region or an independent agent to find out more about the shared funding option.