We’re With You Every Step Of The Way

CBA will institute strategic and tactical plans that will positively reduce your healthcare costs and deliver much more.

Fiscal Guidance

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.

Innovative Health Plan Funding Solutions

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 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

Get in touch now to find out how we can help you.

CBA is a member of a national coalition of brokerage consultancies, known as Benefit Advisors Network (BAN).

BAN is a very selective national network of one hundred (100) like-minded firms. It is truly the premier national, credentialed network of independent employee benefits consulting firms and its member-firms are among the most progressive employee benefits specialists in the United States. CBA’s membership in BAN enhances our ability to deliver additional industry-leading services in the areas of: technology, underwriting, stop/loss, legal & compliance, actuarial services, data analytics, captives and more.