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Understanding Level Funding: The Balancing Act for Your Business Health Plan


Understanding level funding

In the complex world of insurance plans, finding the right fit for your business can be a daunting task. You want the freedom and flexibility of a self-funded insurance plan, but with the added certainty of stable budgeting. This is where level funding steps in, presenting a promising solution for businesses seeking balance. Let's explore the advantages and disadvantages of level funding and how it might align with your company's unique needs.

Unveiling Self-Funded Plans

To understand level funding, you must first understand self-funding. A self-funded health plan puts the employer in the driver's seat, assuming the risk and responsibility for medical claims. Unlike traditional insurance plans, where an external carrier handles claims and sets premiums, a self-funded plan allows employers to set premium rates based on claims history. This grants greater control over plan design, cash flow, and administrative costs, making it an attractive option for many businesses.

However, self-funding is not without its challenges. Employers need to manage fluctuating expenses, paying claims as they arise. Here's where level funding comes into play, offering a solution to mitigate unpredictability while retaining the advantages of a self-funded plan.


The Level Funding Advantage

Level funding is designed to add predictability to a self-funded health plan, simplifying budgeting for employers. With this approach, employers pay a fixed monthly amount to a carrier, encompassing administrative fees, estimated claims, and embedded stop-loss insurance. The carrier manages claims throughout the year, handling any surplus or shortfall at the end of the plan year.

How does it work?


How is the total monthly payment calculated in a level funded plan?

Maximum Claim Liability: An estimated maximum claim liability for the year is set, offering a predictable cap on potential claims.

Health Plan Administration Fee: This fee covers essential administrative functions, ensuring smooth plan operation.

Stop-loss Insurance Premium: Providing a safety net against unexpected high claims, this premium ensures financial protection for the employer.

The total monthly payment is predetermined for a 12-month period, promoting financial stability and predictability for the employer. If claims fall below projections, the employer receives a refund at the end of the year, maximizing cost-efficiency.

The Upsides of Level Funding

Level funding can save an employer 17% of their health care spend.

Level funding offers compelling advantages for businesses:


  1. No Community Premiums: Payments are based only on actual claims, avoiding unnecessary expenses tied to community rates.

  2. Cost-Efficiency: Surplus funds from low claims can be refunded, ensuring your money isn't lost or underutilized.

  3. Enhanced Reporting: Level funding provides insightful utilization reports, aiding in targeted employee education for better healthcare decisions.

Moreover, businesses operating under a level funding model benefit from fewer governmental regulations, presenting a streamlined approach to health plan management.

The Considerations: Disadvantages of Level Funding

While level funding is enticing, it's essential to weigh potential drawbacks:

  1. Administrative Fees: Part of the monthly payment covers administrative fees, potentially affecting cost savings.

  2. Out-of-Pocket Claims Costs: High claim volumes could increase out-of-pocket costs, necessitating careful financial planning.

  3. Contractual Impact: Understanding the nuances of level funding contracts is crucial, requiring expertise for effective decision-making.

Choosing level funding demands careful consideration of your business size, risk tolerance, and budgeting preferences. An experienced expert can guide you through the nuances, ensuring your choice aligns with your unique needs.

Your Decision Matters

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Level funded health plans offer a tantalizing blend of stability, cost savings, and flexibility. When contemplating self-funded health plans, level funding is a viable option, aligning with your company’s financial capabilities, risk tolerance, and employee numbers. The ultimate choice rests on your business's strategy, aiming for the optimal balance between financial predictability and cost-effectiveness.

For further insights and information about employee health plans and other benefits, reach out to Otegrity, where expertise meets tailored solutions.



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