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The words “self-funding” often make clients uncomfortable.
They don’t have to.
Simplified Funding Concepts1(“SFC”) helps take the fear out of self-funding. It offers:
1. An ACA-compliant alternative – Employers want alternatives to fully insured Obamacare plans, and SFC provides one. Self-funded health benefit plans are governed under ERISA and fulfill the Affordable Care Act’s Employer Mandate. Along with being an ACA-compliant alternative, this coverage can also be used by plans grandfathered under Obamacare that wish to change benefits but want to avoid moving to Obamacare metal plans.
2. Business as usual for employees – the SFC’s health benefit plans look and act similar to fully insured coverage, and employees won’t notice the difference.
3 Built-in protections – If a member’s covered medical claims exceed the predetermined threshold, the specific stop-loss insurance reimburses the plan for the excess amount. To limit the employer’s maximum claim liability, a monthly aggregate accommodation benefit pays when the total claims for all covered employees and dependents exceed a pre-determined amount.
4. Numerous health benefit plan options – Employers can design coverage that best meets employee needs. SFC offers a range of out-of-pocket and deductible amounts—along with office copays and drug cards.
5. An HSA/HRA version – A qualified SFC health benefit plan option is available to employers that want to offer their employees a health savings or health reimbursement account.
6. Tremendous PPO network options nationwide – In an era where slimming down networks is the trend, the SFC health benefit plan offers a robust PPO network with numerous participating providers nationwide. Management carve-outs available for employers who want to offer the health benefit plan to management and not hourly employees.
7. A single monthly payment – One monthly payment is applied to the claims account, administrative plan expenses and stop-loss insurance premium.
8. The return of unused money – If claims do not exceed the employer’s annual funding limit at the end of the claims run-out period, the employer may apply the unused claims funds to future program costs or request the remaining fund balance.
9. Composite rates – For those who want to make offering benefits easier, SFC offers four-tier rating based on group demographics.
10. Electronic group enrollment – Quick, simple and paper-free, SFC employer and employee enrollment forms are available on FormFire and EasyApps.
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1Simplified Funding Concepts The IHC Group provides a program to establish and maintain a self-funded health plan coordinated with stop-loss insurance protection for employers with 10 to 50 enrolled employees. The program is not available in all states. Administrative services for the self-funded health plan are provided by licensed Third Party Administrators (TPA). The stop-loss insurance is underwritten by Independence American Insurance Company (“IAIC”), under policy form series SL2014-IAIC and SL2004-IAIC. IAIC is a member of The IHC Group. The TPAs are not members of The IHC Group. Self-funded health benefit plans are governed by federal law under the Employee Retirement Income Security Act (ERISA).