Self-Funded Group Plans

Our self-funded plans give your company control over your healthcare costs and the flexibility that you need.

Call 1-800-851-3379, ext. 8024 to get started.

We currently don't offer self-funded group plans in your area.

Provider Relationships

We don't just have contracts with providers, we have real relationships and partnerships with our providers to bring your employees integrated care every step of the way.

Personalized Plans

With a variety of plans, programs, and customizations, we can help your company get what it needs, from benefits and financial services, to controlling costs and risk.

Speed of Innovation

We are the perfect size to move with trends quickly, so we're ahead of the game in bringing your company advancements, new extras, and better service.


 

Why Self-Funded?

Self-funded plans are a great option for budget-savvy business owners who want more control over their company’s healthcare coverage costs.

You can choose from a range of self-funded stock plan designs or build your own plan. You’ll have peace of mind knowing you’re offering top-notch healthcare coverage that fits your company’s specific needs and budget.

 

What is Self-Funded?

With a self-funded plan, you retain the risks and rewards of paying for your employees’ health care.

In comparison, fully insured plans pass the risk and rewards on to the insurance company in exchange for a fixed premium.

Savings

Companies that choose self-funding have the opportunity to save money when plan participants have few claims and few expensive illnesses.

Protection

We offer additional stop-loss coverage to protect your business during periods of high medical claim expenses. This provides financial security by allowing you to set a yearly guaranteed annual plan maximum cost for your business.

Specific stop-loss coverage limits the plan’s financial exposure on any one individual. Aggregate stop-loss limits the plan’s financial liability for all eligible plan participants.

Support

We make self-funding easier for you by coordinating essential services, like:

  • Claims Administration
  • Medical Management
  • Pharmacy Benefits

Reporting

Plus, we provide clear reports and documentation of how every dollar is spent, helping you manage the plan effectively.

Your business owns all the data associated with your plan participants, and usage. You can see claims info, medical history, and more. This allows for smarter and more agile planning for future healthcare costs.

Self-Funded vs. Fully Insured

Most self-funded plans are not subject to the taxes and fees that apply to fully insured plans.

Businesses have the potential to save money when claims are lower than expected.

Most plans follow federal ERISA rules and are not subject to most state mandates*, like bariatric surgery.

*If your plan is not governed by ERISA, some state mandates may apply.

Fully insured plans are subject to taxes and fees.

Businesses pay insurance company a fixed rate, no matter if claims are high or low.

Subject to all state mandates.

 

 

Wellness Extras

We offer programs and tools to help your employees be healthier, which could mean lower claim costs for your plan.

Rally, our online tool that helps people make healthy choices

 

Note: These extras are included in your plan at no cost. Others are available as add-ons to your plan. Talk to your client consultant to learn more.

Take Control of Your Coverage with BenefitFocus

 
BenefitFocus* helps you better understand how your employees are using their coverage and how the plan is performing overall, so you can make more informed, cost-effective decisions.

It gives you the complete picture of your health plan costs, including claims data and administrative expenses, and provides a streamlined process to filter, build, and save reports with interactive online features.

Learn More

*Previously known as Benefit Informatics

 

When members register for Your Health Alliance get instant access anytime, anywhere. They can:

  • Order a new ID card
  • Find doctors, hospitals, and pharmacies covered by your plan
  • View past and current claims, authorizations, and Explanations of Benefits
  • Check your deductible and out-of-pocket balances

Get Started

Getting Started
 

Call Us

Call Us

Talk to a client consultant at 1-800-851-3379, ext. 8024.

Resources For Your Business

 


Important: This information is not intended to be legal or tax advice and should not be taken as such. We strongly encourage you to get such advice from professional legal or tax counsel to determine how to best accommodate and protect the needs of your health plan and related business.

Health Alliance and its affiliates are not responsible for any complication or loss sustained by any entity choosing to rely on information presented here.