Funding Alternatives
We’re With You Every Step Of The Way
Innovative Health Plan Funding Solutions
CBA will institute strategic and tactical plans that will positively reduce your healthcare costs and deliver much more. What’s truly driving your company’s healthcare costs? How about 70% of your claims dollars being incurred by 30% of your members. It’s also very expensive, and ever-escalating, Prescription Drug costs. Let us show you through an actuarial claims study and share multiple strategies you can immediately use to significantly impact those cost drivers.
Fully Insured
• Insurance company retains 100% of profit
• Fixed monthly cost
• State premium taxes
• State coverage mandates apply
• Insurance company profit
• Admin included, but not transparent
• Fixed cost pooling
• Little to no transparency in claims
• Wellness programs less impactful
Private Exchanges
• The Bright Choice Exchange®
• Employees shop plans with decision support technology
• Defined contribution strategy, employer sets the amount of money to allocate
• Employees “shop” in the exchange where they choose from medical, ancillary & voluntary benefit plans
Self-Funded (Level Funded)
• Fixed monthly cost
• Maximum liability defined at outset
• Avoids State and many Federal mandated benefits
• Avoids State premium taxes
• Surplus retained by plan sponsors (50–100%)
• Stop/Loss – potentially shopped annually, but usually proprietary
• Better claims transparency than fully- insured (Fixed+Claims)
Self-Funded (Consortiums)
• Fixed monthly costs
• Maximum liability defined at outset
• Avoids State and Federal mandated benefits
• Avoids State premium taxes
• Surplus retained by plan sponsor
• Stop/Loss – potentially shopped annually
• Better claims transparency than fully insured
• Multiple employer- leveraged buying power for Admin & Stop/Loss
Self-Funded (Captives)
• Fixed monthly cost
• Shared Risk Captive Layer up to a higher ISL
• Avoids State and Federal mandated benefits
• Avoids State premium taxes
• Surplus retained by plan sponsors
• Stop/Loss – potentially shopped annually as a block
• Full claims transparency
• Each employer pays into the group captive-pool to cover medium-sized claims.
Self-Funded Carrier (ASO)
• Insurance company adjudicates claims & plan sponsor pays
• Utilize networks of insurance company
• Stop/Loss usually on carrier paper & cannot be shopped annually
• PMPM fees
• Claims paid as incurred, more volatile cash-flow to plan sponsor
• Carrier or seldom allows an Independent PBM solutions
• Full claims transparency
Referenced Based-Pricing
• TPA used to create ERISA plan doc & adjudicate claims as co-fiduciary
• Renting physician only PPO network
• Facilities claims > $5k audited & paid at cost+ or % of Medicare
• Stop/Loss shopped annually
• PMPM fees
• Claims adjudicated by TPA and paid by plan sponsor
• Facilitiesclaims paid at set $ rates, not a % of contract rate
• Multiple PBM solutions
• Full claims transparency
Self-Funded With TPA
• TPA used to adjudicate claims
• Renting PPO networks nationally
• Stop/Loss can be shopped annually
• PMPM fees
• Claims adjudicated by TPA and paid by plan sponsor
• Claims paid as incurred, more volatile cash-flow to plan sponsor
• Multiple PBM solutions
• Full claims transparency
Professional Employer Orgs. (PEO)
Co-Employer or Administrative Service Only (ASO) arrangement for smaller employers to outsource all costs & functions related to:
• Payroll
• Benefits
• Legal/Tax/HR Compliance
• Healthcare Reform/ACA Compliance
• Risk Management
• HR Administration
• Human Capital Management Functions
• Recruiting
• Workers Comp
• 401(k) Retirement Plan
How Can We Help You?
We Provide the Tools and Expertise You Need to Succeed
