Set Yourself Apart with Level-Funded Health Plans

Jennifer Agnello

Jennifer Agnello | President

It’s about that time again. Another fourth quarter is right around the corner and your clients may be quite tired of the same old story: Another increase, another change in benefits, another quoting season, and the expectation of bad news. What if you could provide hope, grow your book of business, and add unique value to help your small business clients save money all at the same time? The implementation of the Affordable Care Act (ACA) has been both challenging and confusing for many employers. ACA community rating has benefited a few traditionally “less healthy” groups, however the rating methodology, compliance hurdles, and cost (at least in Ohio) have kept most groups in steadily shrinking transitional plans.

As in any challenging situation, creative minds rise to the occasion. In this case, newer-to-market level-funded health plans are an intriguing alternative to ACA plans for small businesses.

Level-funded products are designed to give clients the benefits and advantages of self-funding, while limiting the disadvantages by offering a “pre-packaged” hybrid of self-insurance for small employers (down to five enrolled locally). Historically, small businesses did not have the opportunity to self-insure their health coverage. Healthy groups continued to absorb increases of the pools of business, which became sicker over time. Today, many commercial carriers are offering level-funded plans that curtail claim volatility through fixed monthly premiums with the added bonus of a potential refund if claim costs are less than expected. These plans allow the small business to see the financial benefits that self-funded plans traditionally offered only to large groups.

So, why consider level-funded plans?

  • Premium payments are predictable and fixed monthly, avoiding volatility in monthly cash flows and risk of claims exceeding the monthly payments. Employers pay fixed premiums to cover claims funding, stop-loss premium, and administrative fees. Employers are not responsible for claims exceeding those fixed payments for those received during the 48 months following the end of the first year.
  • When is the last time you were able to tell your small group client they may be eligible for a refund? That’s right, a refund. Most level-funded plans refund a portion of the unused claims surplus at the end of the year, dependent upon the plan’s experience. After a three- to six-month run out period, the client’s performance is evaluated and a portion of allotted claims dollars may be returned if they have run below maximum claim expectations (most carriers require that you renew with them to receive this reimbursement). The refund can be used to offset future increases.
  • Level-funded plans are exempt from state taxes on premiums (usually 2–3 percent of the total premium). In this case, only stop loss premiums are taxed. They are also exempt from the ACA’s Health Insurance Tax. The ACA does require all self-funded plans to pay an annual PCORI fee ($2.39 for 2019) and they are required to comply with ACA reporting requirements like an Applicable Large Employer.
  • Level-funded plans use medical underwriting and gender/age ratings, allowing healthier workforces to pay lower premiums. Community rating—required by ACA-regulated health plans—is avoided. Younger, healthier groups may benefit.
  • These types of plans are not subject to state-mandated benefits that allow small employers to tailor their coverage to their employees’ needs.
  • Greater transparency is evident in reporting provided by each carrier with respect to costs breakdown.
  • You will stand out as a valued consultant to your client! Many brokers have not yet taken to these new plans and continue to run their business as status quo. Bringing new ideas to save costs will enable you to grow your book of business as you so choose.

Level-funded plans are a great option for many employers, but they are complex. Brokers who serve small-group clients need to be trained on their structure, underwriting methodology, costs, and implementation to be well versed in their approach.

Cornerstone offers the training, guidance, and tools to make you an expert. Let us add value to your agency today. Call one of our A+ professionals to get started.

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