Large group funding options

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+ employees 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.

For Employers

Large group health plan funding options