Fully-Funded

All annual costs to the employer are fixed and built into the cost of the premium and all risk is assumed by the insurance carrier.

• Fit for risk-averse groups
• Predictable monthly expenses
• Limit fiduciary responsibility

Level-Funded

Health insurance plan that combines the cost savings and customization of self-funding with the financial safety and predictability of fully funded plans.

Self-Funded

Employer sponsored healthcare that does not use traditional insurance carriers as a conduit for medical care, premiums are paid to the employer and used to pay medical claims. The employer pays for claims as they are incurred, administrative costs are fixed while other costs are variable, and all claims risk is assumed by the employer until stop loss is triggered. Fiduciary responsibilities are included — such as ACA notices and compliance with federal mandates. A good fit for those that have cash flow and reserve funds to allow for fluctuations, have administrative support to manage, and want to customize their plans.

Medicare Premiums

Employers that sponsor group health plans and have employees who are Medicare-eligible may be interested  in reimbursing their employees’ Medicare premiums. In general, when an employee is elibigle for Medicare due to age, an employer may reimburse his or her Medicare premiums only when:

The employer’s group health plan is a secondary payer to Medicare because the employer has fewer than 20 employees; AND

The reimbursement arrangement complies with the Affordable Care Act (ACA) because it satisfies certain design requirements (or covers fewer than two employees).

Employers may offer an individual coverage health reimbursement arrangement (HRA) to reimburse their eligible employees for insurance policies purchased in the individual market, or for Medicare premiums, as an alternative to traditional group health plan coverage, subject to certain conditions.

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