Now Available in North Carolina

In today's world, many companies are turning away from offering fully insured health insurance plans to their employees. Instead, they are choosing a different way to give health insurance to their workers: Self-funding.

Self-funded insurance plans give companies and their employees more control and flexibility, allowing brokers to capture new clients and keep current ones. At Planned Administrators, Inc. (PAI), we work closely with our clients and partners to craft tailored self-funded plans.

What is Self-Funding?

Self-funding is a way companies pay for their employees' healthcare costs. Instead of paying expensive monthly premiums for a fixed insurance plan, the company sets aside money to cover these costs themselves.

In other words, it's like having a piggy bank for healthcare. When employees need medical care, the money from this "piggy bank" is used to pay for it. This gives the company more control over the benefits it offers. They can customize the plan to support the employees’ wellness goals and save money by only paying for the healthcare services rendered.

It's a bit like DIY healthcare insurance, where the company takes on the responsibility of managing and paying for their employees' healthcare expenses directly, with the help of a Third Party Administrator (TPA) like PAI.

The Role of Stop Loss Insurance

Stop-loss insurance protects companies from unexpected and potentially catastrophic medical claims. It works like a financial buffer, kicking in when claims exceed a certain threshold, known as the stop loss limit. This ensures that employers are not left financially vulnerable in the event of an unusually high healthcare claims year.

There are two types of stop-loss insurance — specific and aggregate. Specific stop-loss covers individual catastrophic claims, reimbursing the employer for costs exceeding a predetermined deductible. Aggregate stop loss protects against total claims exceeding an expected threshold for all employees within a year.

Specific Stop-Loss Insurance

Specific stop-loss insurance shields employers from shouldering the full financial burden in cases of severe illness with high-cost claims. Employers choose a deductible, covering expenses below that amount. The insurer reimburses eligible claims surpassing the deductible.

For instance, with a $25,000 deductible and a $75,000 claim, the insurer covers $50,000, easing the employer's financial responsibility.

Aggregate Stop-Loss Insurance

Employers can use aggregate stop-loss insurance to avoid having to pay the total cost of their employees’ claims during the year past a certain amount. If the claims exceed the aggregate deductible, the insurer compensates the employer.

For example, if a company expected to spend $1 million on claims in a year but ended up with $1.5 million in claims, and their insurance had an aggregate corridor set at 125%, the insurer would reimburse $250,000.

An aggregate corridor is the range between the expected total claims amount and the attachment point, where aggregate stop-loss coverage starts reimbursing for claims exceeding the threshold. Dental, vision, and/or short-term disability benefits can also be covered under aggregate stop-loss insurance.

Expect More With PAI

We know brokers and benefit advisors play a vital role in helping companies navigate the complex world of benefits. Agents and their clients seeking self-funded plans can benefit greatly by partnering with PAI. Instead of managing the complexities of self-funded plans alone, brokers can rely on PAI's expertise to streamline the process and provide tailored solutions for their clients.

Advantages of Offering PAI’s Self-Funded Options

•    Strong network savings.
•    Plan design flexibility.
•    Integrated solutions offering seamless experiences.
•    Comprehensive vendor partnerships to target plan optimization.
•    Best-in-class administration to enhance plan manageability.
•    Focus on cost containment strategies increases plan performance and overall savings. 
•    Extensive analytics and data interpretation support to drive strategies and improve performance.

Now Available in North Carolina

In Partnership With Proactive MD

PAI recently expanded our services to Georgia, including our Reference-Based Pricing 2.0 model. Now, our team is excitedly stepping into North Carolina to continue sharing our care solutions across the country.

Our partnership with Proactive MD allows us to continually optimize our health solutions while lowering the total cost of care for members and employers. This dynamic partnership means brokers have access to cutting-edge solutions that prioritize proactive, personalized care for their clients. This leads to better client retention and provides more incentive for prospects to sign.

Our joint solution revolutionizes the way healthcare is delivered and empowers employers to take control of their healthcare costs. We prioritize prevention and wellness to ensure employees receive top-notch care. This partnership is not just about offering another healthcare option, it's about transforming lives and businesses for the better.

Continue Learning About Self-Funded Plans

Are you a broker or employer hoping to learn more about the benefits of Self-funding? Take the first step today to explore the benefits of self-funded plans with PAI and elevate you to new heights of success. Your clients—and your business—will thank you.