(On and Off Exchange)

(Off Exchange Only)

(Short-Term Plans Only)

(Must have a compatible plan)

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Your group renewal will be coming soon.  If your group is 25 or more enrolled (6 or more with some other carriers) and has excellent claims vs. premium history, we will also request a quote from BCBSTX for their partially self-funded plan called Blue Balance Funded.  With group size of 6 to 25 we can request a self-funded quote from UHC on their All Savers platform or Aetna for their Funding Advantage plan. These products can save you premium if your claim history has run well.  Depending upon your current carrier we may ask you to sign a document to obtain information about your claim history.

There are some trade-offs with a partially self-funded plan.  These are:

  1. Some medical issues currently covered under ACA fully insured plans are not covered under partially self-funded plans.
  2. Your group would be responsible for the 1065 filing that is currently being done by the insurance carrier (required for carrier when fully insured).
  3. The group would also have to calculate and pay the PCORI fee currently paid by the carrier.
  4. Monthly payment, required for funding claims payments, has stricter receipt guidelines than premium on your current fully insured plan. Most require bank drafts near the first of each month.

The savings with the self-funded option needs to be 8% or more to justify the additional costs and reporting burdens required with a self-funded plan option.

If your group has a grandfathered or grandmothered (transitional) plan, these self-funded plans usually are NOT LOWER in premium than your current fully insured plan renewal.  It would not make sense to give up a grandfathered or grandmothered plan in most cases, as you would not experience savings and you would pick up additional reporting and payment obligations.

If your group is renewing a fully insured ACA plan(s) and if claims have not run well over the last 12 months; then the self-funded plan quote will probably not compete with your fully insured ACA renewal.

When your renewal is available, we will assist you in reviewing all options to determine the best fit for your company and employees.