Fully funded
Lowest financial risk, lowest plan flexibility
- Great for employers with 2-500+ employees who want consistent monthly costs for their health benefits
- Stable monthly premium paid to the insurance carrier
- Minimal risk for employer as insurance carrier administers the plan and pays out the claims incurred
- Subject to all state and federal regulations with limited plan design flexibility
Optimized level funded option (OLFO)
Predictable costs, shared savings—no downside risk
- Ideal for employers with 5-99 enrolled contracts ready to move beyond fully funded plans but not yet ready for full self-funding
- Pay a consistent monthly amount that covers administration, stop-loss insurance, and claims funding
- Enjoy financial predictability with no risk of paying back if claims exceed funding
- If claims are lower than expected, receive 50% of the surplus back at year-end
Self-funded
Highest financial risk, highest plan flexibility
- Best for employers with 51+ enrolled contracts who want plan flexibility and can manage fluctuating costs
- Low monthly administrative fee paid to carrier who manages administration of employer's plan
- Health plan processes claims paid with funds set aside by employer
- Less regulation with high flexibility and low fees but variable monthly costs
- Rx carve out available with 100+ enrolled contracts
- Stoploss carve out available with 51+ enrolled contracts
NEW! TPA solution
Priority Health and Healthcare Management Administrators (HMA) have collaborated to offer a TPA (third-party administrator) solution for self-funded Michigan-based employers with 100+ employees. This new solution combines HMA’s expertise in self-funded health plans with Priority Health’s extensive network and provides employers with flexibility, control and the support they need to achieve healthier outcomes for employees at the best possible value.